Time / Date: 10/31/2025 6:12:11
JSP ID: 4267
Scope of Work: Shutting down the MCC to install new breaker and wiring to a new vfd.
Work Order:
Building: 088
Person in Charge: Erik Line
Lead / Supervisor: Keusch, Justen
Logged Email: Eline@lbl.gov
Division: Facilities
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: Tim Nguyen
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 80A7 and 80A7A-13
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.

1. Open breaker 80A7 in cubicle 3c (feeds MCC in the pump room) 2. Rack out breaker 80A7 3. Establish LOTO 4. ZVV at cubicle 13 in the MCC and verify electrically safe to work. 5. Demo old motor starter and old breaker. 6. Install new breaker and relay. 7. Get inspected 8. Release LOTO 9. Restore Power.

Control of Work Area

Minimum Approach Boundary: 134" for the tx pad and 29" for the MCC
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: 27.1 cal/cm2
Arc Flash Boundary: 134"
Working Distance: 24 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location: West side of the TX pad.
Emergency Number to Call: 510-486-6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Control Room
Fire Extinguisher Location: Bottom of the stairs on the tx pad and in the entry of the pump room
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

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

N/A

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,
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