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Time / Date: 8/5/2025 8:08:55
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JSP ID: 4009
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Scope of Work: Replacement of actuators and sensors
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Work Order: W0323190
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Building: 64
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Person in Charge: Gerald Fowler
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Lead / Supervisor: Delgado, Alex
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Logged Email: juanjuarez37@lbl.gov
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Division: Facilities
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QEW Level: QEW 2
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Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
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Second Person Requirement: Safety Watch
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Second Person Identified: Juan juarez
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List Other Participants: Mike Kenny, Chris Hughes, Justin caringellow, Matthew Baxter,
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Affected Persons Notified: Yes
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Switching: Hazardous Switching
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Panel / Equipment ID: 266A40A3A/5 - 64BR008
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System Information Review: Arc Flash Labels
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Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
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Equipment Condition: Properly installed, Properly maintained, All doors and covers closed and fully latched, No signs of impending failure, Not energizing equipment for the first time, or after electrical repair
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Sequence of Job Steps
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List basic sequence of steps from start to finish.
We will establish loto and ZVV protocols , we will replaced old part and install new ones . |
Control of Work Area
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Minimum Approach Boundary: 92”
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Barricade Tape / Attendant: Attendant
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Shock Risk Assessment
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System Voltage: 120/208 V ac
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Limited Approach Boundary: 42 inches
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Restricted Approach Boundary: 12 inches
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Will the hands enter the RAB: Yes
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Voltage Glove Class: 0
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Will any other part of the body enter the RAB: No
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Arc Flash Risk Assessment
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Incident Energy: 23.4 cal/cm2
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Arc Flash Boundary: 93
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Working Distance: 18 inches
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Arc Flash PPE Level: 4
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Incident Energy Reduction Measures: 0
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Capacitor Hazards
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Capacitor Bus Voltage:
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Capacitor total stored energy (joules):
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Discharge wait time (minutes):
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Emergency Response Plan
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Nearest Landline Location: Inside building next to unit b64
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Emergency Number to Call: 7911
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Sufficient cell phone signal? Yes
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Clear exit path? Yes
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AED Location: Front of 142 b64
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Fire Extinguisher Location: Front of 146 b 64
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Contact release method available and tested: Voltage gloves
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Environmental Conditions
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Does the environment present additional hazards that should be addressed?
Heavy traffic |
Error Precursors
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Task Demands:
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Work Environment:
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Individual Capabilities:
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Human Nature:
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Error Precursor Mitigations:
Multiple crafts , stay focus |
PPE Inspections
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Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit, daily wear) including face shield, balaclava, hood., Hearing protection, Rubber insulating gloves and leather protectors, Non-melting footwear that fully covers the feet, Removal of conductive articles, Insulated tools, Multimeter and other electrical test instruments, |
Notes / Other
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Perform Job Breifing
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PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.
A Job Briefing at a minimum must include:
Rev 2023.08.22.1 Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov |