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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 12/2/2025 7:26:48
JSP ID: 4359
Scope of Work: Turn off circuit breaker 9 and 15 in Panel 320A and perform ZVV on SO80514 and SO80714

General Information

Work Order
415067
Building
Building 6
Person in Charge
Jevon Mattiassi
Lead / Supervisor
Keusch, Justen
Logged Email
jevonmattiassi@lbl.gov
Division
ALS

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
Chris Nelsonn
Other Participants
IT, ALS EM, RI
Affected Persons Notified
Yes

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
Panel 320A/ BA SO80514, BA SO80714
System Information Review
☑ 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
Fill out JSP. Inspect PPE. Put up baricades and signs. Inform ALS control room and EM shop and affected personnel. When ready for switching wear proper PPE. Stand to side and switch breaker 9 off. Apply LOTO. Stand to side and switch breaker 15. Apply LOTO. Perform ZVV with second person. When ZVV is done, put panel back together and keep breakers LOTO until work is complete and LOTO can be released and panel can be reenergized.

Control of Work Area

Minimum Approach Boundary
95
Barricade Tape / Attendant
Warning - Orange

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
17.1 cal/cm2
Arc Flash Boundary
95
Working Distance
18 inches
Arc Flash PPE Level
4
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
Rack SO825
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Main lobby entrance at sector 6
Fire Extinguisher Location
BA Rack SO824
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient lighting, Confined space, Insufficient/cramped/awkward space, Heavy traffic, Noisy environment

Error Precursors

Task Demands
Repetitive actions or monotony
Work Environment
Distractions/interruptions
Individual Capabilities
Human Nature
Stress (limits attention), Habit patterns, Complacency/overconfidence
Error Precursor Mitigations
Stay focused on task at hand and communicate with my standby.

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

Will reenergize today

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
Rev 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov