Time / Date: 1/9/2023 9:45:17
JSP ID: 417
Scope of Work: open panel and inspect for water intrusion
Work Order: 307820
Building:
Person in Charge: Nick gripe
Lead / Supervisor: Secheck, Stephen
Logged Email: jtissot@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Standby Person
Second Person Identified: Shane miller
List Other Participants: Stephen sechak Jared tissot
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: 238A3A2A
System Information Review: Single Line Drawing, Panel Schedules, 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.

Dawn PPE, open panel, inspect, close panel

Control of Work Area

Minimum Approach Boundary: 42in
Barricade Tape / Attendant: Danger - Red, Attendant

Shock Risk Assessment

System Voltage: 277/480 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: No
Voltage Glove Class: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 1.8 overdutied cal/cm2
Arc Flash Boundary: 23in
Working Distance: 18 inches
Arc Flash PPE Level: 4
Incident Energy Reduction Measures: 00

Capacitor Hazards

Capacitor Bus Voltage: Na
Capacitor total stored energy (joules): Na
Discharge wait time (minutes): Na

Emergency Response Plan

Nearest Landline Location: B2
Emergency Number to Call: B2
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: B2
Fire Extinguisher Location: B2
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient lighting

Error Precursors

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

Na

PPE Inspections

Notes / Other

Na

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