QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

468011

Building

53

Person in Charge

Capeto

Lead / Supervisor

Delgado, Alex

Logged Email

mcapeto@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

Other Participants

None

Affected Persons Notified

Yes

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

PNL 014 53/ 53 AC 001

System Information Review

☑ 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

switch, LOTO, ZVV, PM, release LOTO, switch, verify ops

Control of Work Area

Minimum Approach Boundary

42”

Barricade Tape / Attendant

Warning - Orange, 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

1.91 cal cal/cm2

Arc Flash Boundary

23”

Working Distance

24 inches

Arc Flash PPE Level

Minimum PPE for Electrical Work

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

Room 006

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

Portable

Fire Extinguisher Location

Roll up door interior/ June 2025

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

Reviewed

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan