Scope of Work:Perform annual test of the emergency fixtures
General Information
Work Order
Turn off breakers then reenergize
Building
90
Person in Charge
Egon Hampton
Lead / Supervisor
Keusch, Justen
Logged Email
efhampton@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Na
Other Participants
Na
Affected Persons Notified
Yes
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
E90A4A9A3A
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Cord & Plug 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
Turn off breakers for the units
Control of Work Area
Minimum Approach Boundary
Signs designating outage time contacts
Barricade Tape / Attendant
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
0
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
No Arc Flash Hazard Present
Arc Flash PPE Level
2
Incident Energy Reduction Measures
0
Capacitor Hazards
Capacitor Bus Voltage
Na
Capacitor Total Stored Energy (Joules)
Na
Discharge Wait Time (Minutes)
Na
Emergency Response Plan
Nearest Landline Location
Lobby
Emergency Number to Call
699
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Lobby
Fire Extinguisher Location
Lobby
Contact Release Method Available and Tested
Non electrical work
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) ☑ Hearing protection ☑ Rubber insulating gloves and leather protectors ☑ Na
Notes / Other
Test of emergency fixtures
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)
