Time / Date: 10/28/2025 9:42:46
JSP ID: 4249
Scope of Work: To change 3-phase transformer taps, verify PFC connections and replace 3-phase input fuses if needed.
Work Order:
Building: 88-Cave 4 Roof
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: Standby Person
Second Person Identified: Shane Blim
List Other Participants:
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: Magwatt M41/42 Power Supply.
System Information Review: Panel Schedules, Arc Flash Labels, LBL and vendor schematics.
Control of Hazardous Energy: Complex LOTO w/ RI
Equipment Condition: Properly installed, Properly maintained, All doors and covers closed and fully latched, No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish.

-Place new M41/42 power supply in LOTO. -Reposition the three XFMR tap cables to 4-5. -Remove the PFC cover and check all 3 input fuses to ensure they are still intact after the 3-phase circuit breaker located outside the building failed, and replace any fuses if blown. -Un-LOTO M41/42 power supply and take PF while at load. -Come out of LOTO and take PF measurement under load.

Control of Work Area

Minimum Approach Boundary: 42 inches
Barricade Tape / Attendant: Notice - Blue, Attendant

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 00
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 0.17 cal/cm2
Arc Flash Boundary: 5
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 00

Capacitor Hazards

Capacitor Bus Voltage: 679
Capacitor total stored energy (joules): 557
Discharge wait time (minutes): 1

Emergency Response Plan

Nearest Landline Location: Control room
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Control room , ground floor
Fire Extinguisher Location: Top of stairs
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Heavy traffic

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities: Unfamiliar with, or first time performing task
Human Nature:
Error Precursor Mitigations:

Work with those familiar, Use documentation, JSP.

PPE Inspections

Safety glasses (ANSI Z87),
Arc-rated clothing (flash suit,
daily wear) including face shield,
balaclava,
hood.,
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

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