QEW 1 / 2 / 3 Job Safety Plan

Time / Date: 12/15/2025 9:15:48

JSP ID: 4403

Scope of Work: LOTO ct. 2 and 15. Demo wiring and 3/4 conduit from labyrinth 10 back to SO 909 4 square switch box. Turn on ct 2 and 15.

General Information

Work Order

None

Building

Person in Charge

Jevon Mattiassi

Lead / Supervisor

Combs, Everett

Logged Email

jmmattiassi@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

Everett Combs

Other Participants

EMs

Affected Persons Notified

Yes

System / Equipment

Switching

Hazardous Switching

Panel / Equipment ID

321A and SO 909

System Information Review

☑ Panel Schedules
☑ Arc Flash Labels

Control of Hazardous Energy

Complex LOTO (requires LP, CLP, FLP)

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. Set up warning tape and signage. Notify EMs that I will be shutting off ct. 2 and 15. Put on all required PPE. Turn off ct. 2 and 15. Apply LOTO. Perform ZVV on receptacle, which is ct 2. Perform zvv at switch which is ct 15. Perform zvv of end of line box. Once zvv is confirmed, demo 3/4 conduit and wiring back to SO 909 4 square switch box. Apply 3/4 ko seal. Make sure all devices are installed correctly. Notify Everett and EMs to reenergize ct 2 and 15. Properly dispose of wiring and conduit.

Control of Work Area

Minimum Approach Boundary

42”

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

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

21.7 cal/cm2

Arc Flash Boundary

89”

Working Distance

18 inches

Arc Flash PPE Level

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

Capacitor Total Stored Energy (Joules)

Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location

By laberanth 10 door

Emergency Number to Call

911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

Loby ALS

Fire Extinguisher Location

Laberanth 10 door

Contact Release Method Available and Tested

Upstream breaker or switch, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment, Noisy environment

Error Precursors

Task Demands

Simultaneous or multiple tasks

Work Environment

Individual Capabilities

Human Nature

Mind-set

Error Precursor Mitigations

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