QEW 1 / 2 / 3 Job Safety Plan
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Time / Date:
8/7/2025 6:28:08
JSP ID:
4014
Scope of Work:
Power down fire alarm control panel and sub panels
General Information
Work Order
W0450812
Building
23
Person in Charge
Peter combs
Lead / Supervisor
Baird, Shawn
Logged Email
pacombs@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 1
Second Person Requirement
Not Required
Second Person Identified
Other Participants
Affected Persons Notified
Yes
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
Panel B by rm 110
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑
Sequence of Job Steps
List basic sequence of steps from start to finish
Our system on test Disconnect battery’s. Switch breaker #23 and #32 on panel B in hallway by 110 Apply locks
Control of Work Area
Minimum Approach Boundary
Barricade Tape / Attendant
Shock Risk Assessment
System Voltage
No Shock Hazard Present
Limited Approach Boundary
None
Restricted Approach Boundary
None
Will the hands enter the RAB
No
Voltage Glove Class
Not Required
Will any other part of the body enter the RAB
No
Arc Flash Risk Assessment
Incident Energy
16 cal cal/cm2
Arc Flash Boundary
No
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
Minimum PPE for Electrical Work
Incident Energy Reduction Measures
Not Required
Capacitor Hazards
Capacitor Bus Voltage
Capacitor Total Stored Energy (Joules)
Discharge Wait Time (Minutes)
Emergency Response Plan
Nearest Landline Location
Lobby
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Lobby
Fire Extinguisher Location
By107
Contact Release Method Available and Tested
Environmental Conditions
Does the environment present additional hazards that should be addressed?
None
Error Precursors
Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
None
PPE Inspections
☑ Safety glasses (ANSI Z87)
☑ Removal of conductive articles
☑ Insulated tools
☑ Leather gloves
Notes / Other
Perform Job Briefing
PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.
A Job Briefing at a minimum must include:
Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan
