QEW 1 / 2 / 3 Job Safety Plan

General Information

Work Order

W0471661

Building

92

Person in Charge

Alma Armenta

Lead / Supervisor

Cameron, Benjamin

Logged Email

alarmenta@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

Joe Pica

Other Participants

Rey E.

Affected Persons Notified

N/A

System / Equipment

Switching

No Switching Required

Panel / Equipment ID

E720E

System Information Review

☑ Arc Flash Labels

Control of Hazardous Energy

Complex LOTO (requires LP, CLP, FLP)

Equipment Condition

☑

Sequence of Job Steps

List basic sequence of steps from start to finish

Lock on to de-energized circuit, don appropriate PPE, zvv, release when work is complete.

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

0.27 cal/cm2

Arc Flash Boundary

42”

Working Distance

18 inches

Arc Flash PPE Level

Minimum PPE for Electrical Work

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

Cell phone

Emergency Number to Call

5104867911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

On hand

Fire Extinguisher Location

In mechanical room

Contact Release Method Available and Tested

Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment, Noisy environment

Error Precursors

Task Demands

Work Environment

Individual Capabilities

Human Nature

Error Precursor Mitigations

None

PPE Inspections

☑ Safety glasses (ANSI Z87)
☑ 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