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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 11/25/2025 10:35:44
JSP ID: 4339
Scope of Work: PM Guard Shack AC 001

General Information

Work Order
451507
Building
-
Person in Charge
Larry Antles
Lead / Supervisor
Delgado, Alex
Logged Email
leantles@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Darren Kranz
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
E374A1A, 33B AC 001
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Properly installed
☑ 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
Obtain Fall Matrix Don Fall Gear LOTO ZVV equipment check and tighten electrical remove and replace filters

Control of Work Area

Minimum Approach Boundary
42”
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 inches
Will the hands enter the RAB
Yes
Voltage Glove Class
0
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
.76 Cal cal/cm2
Arc Flash Boundary
14in
Working Distance
18 inches
Arc Flash PPE Level
2
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
None
Capacitor Total Stored Energy (Joules)
none
Discharge Wait Time (Minutes)
none

Emergency Response Plan

Nearest Landline Location
inside Guard Shack
Emergency Number to Call
6999
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
At unit
Fire Extinguisher Location
in guard shack
Contact Release Method Available and Tested
Upstream breaker or switch, Rescue hook

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Heavy traffic, Fall hazard

Error Precursors

Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Fall Hazards, Electrical, pinch points

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 Briefing

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