Time / Date: 9/29/2025 12:02:24
JSP ID: 4150
Scope of Work: Removing the "AECR Extraction P.S. Remote Control" Chassis.
Work Order:
Building: 88 Cyclotron
Person in Charge: Patrick Coleman
Lead / Supervisor: Other
Logged Email: pcoleman@lbl.gov
Division: Other
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Not Required
Second Person Identified:
List Other Participants:
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: Rack L09 and U03 at the AECR control panel.
System Information Review: Drawings 22W5233 and 22W5244 should be reviewed if not already familiar with this chassis.
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.

Receive approval from source operators for work, Inform Cyclotron OIC work is about to begin and AECR will be out of service. LOTO two 120VAC IEC receptacles on two power supplies. Remove chassis.

Control of Work Area

Minimum Approach Boundary:
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: None
Restricted Approach Boundary: 3 inches
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: None cal/cm2
Arc Flash Boundary: None
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: At the AECR control panel
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Cyclotron control room
Fire Extinguisher Location: Top of stairs
Contact release method available and tested:

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Similar equipment, look for labels.

PPE Inspections

Safety glasses (ANSI Z87),
Non-melting footwear that fully covers the feet,
Removal of conductive articles

Notes / Other

Perform Job Breifing

PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.

A Job Briefing at a minimum must include:
  1. Detailed Scope of Work
  2. Shock and arc flash hazards for each task
  3. Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
  4. Work area controls (barricades, signs, attendants)
  5. Emergency Response Plan

Rev 2023.08.22.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov