QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

W0441633

Building

90

Person in Charge

Arnel Jugarap

Lead / Supervisor

Keusch, Justen

Logged Email

efhampton@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 1 - LOTO & Zero Voltage Verification

QEW Level

QEW 2

Second Person Requirement

Not Required

Second Person Identified

Sayee Chea

Other Participants

Balbino maecadal Egon Hampton

Affected Persons Notified

Yes

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

E90A4A9A3A

System Information Review

☑ Arc Flash Labels

Control of Hazardous Energy

Simple LOTO

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

Sequence of Job Steps

List basic sequence of steps from start to finish

performed lotto performed zvv replace ballast and lamps renergize remove lotto

Control of Work Area

Minimum Approach Boundary

Stand by

Barricade Tape / Attendant

Attendant

Shock Risk Assessment

System Voltage

277/480 V ac

Limited Approach Boundary

42 inches

Restricted Approach Boundary

3 inches

Will the hands enter the RAB

Yes

Voltage Glove Class

Will any other part of the body enter the RAB

No

Arc Flash Risk Assessment

Incident Energy

4.7 cal/cm2

Arc Flash Boundary

42”

Working Distance

24 inches

Arc Flash PPE Level

2

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

Na

Capacitor Total Stored Energy (Joules)

Na

Discharge Wait Time (Minutes)

Na

Emergency Response Plan

Nearest Landline Location

By elevator

Emergency Number to Call

699

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

1st fi entryway

Fire Extinguisher Location

Every floor at elevator

Contact Release Method Available and Tested

Upstream breaker or switch, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Na

Error Precursors

Task Demands

Work Environment

Individual Capabilities

Human Nature

Error Precursor Mitigations

Na

PPE Inspections

☑ 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
☑ Scaffolding

Notes / Other

Na

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