Time / Date: 10/30/2025 11:56:22
JSP ID: 4261
Scope of Work: Accel Air Systems performing maintenance and repairs to Cooling Tower 5
Work Order: NA
Building: B59
Person in Charge: Ernie Jew
Lead / Supervisor: Other
Logged Email: ejew@lbl.gov
Division: Comp Sci
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Jeremy Lang
List Other Participants: Accel Air Systems techs
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Cooling Tower 5
System Information Review: Panel Schedules, Arc Flash Labels
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, Not energizing equipment for the first time, or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish.

Notify the control room operator Turn off CT5 at BMS Turn off CT5 at VFD Hang Group LOTO lock and tag at VFD Hang Group LOTO lock and tag at fan drive shaft lock out device Place both Group LOTO keys in lock box and hang RI lock and tag on lock box Brief workers and have them hang LOTO lock ang tag on lock box Let workers perform work

Control of Work Area

Minimum Approach Boundary: 42"
Barricade Tape / Attendant: 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: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 0.71 cal/cm2
Arc Flash Boundary: 13"
Working Distance: 18 inches
Arc Flash PPE Level: 1
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: Control Room
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Mechanical Level elevator lobby
Fire Extinguisher Location: Mechanical Level next to Tower Water Pumps
Contact release method available and tested: Rescue hook

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location, Confined space, Fall hazard

Error Precursors

Task Demands: Simultaneous or multiple tasks
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Look alike equipment, so take time to identify equipment before switching, and match isolation points to LOTO permit

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

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