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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 1/9/2026 8:55:01
JSP ID: 4438
Scope of Work: Loto and ZVV circuit to change receptacle for new Power Reel Cable Spooler also remove one existing receptacle from the circuit.

General Information

Work Order
415062
Building
53
Person in Charge
Christopher Nelson
Lead / Supervisor
Combs, Everett
Logged Email
cnelson@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
15A15A68A
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 select PPE and inspect all PPE and tools. Set up barricades warning tape and signs. Switch Breaker and ZVV at the first receptacle. When Zero Voltage is established. Begin work. When work is done and in an electrically safe condition re energize and test new Receptacle.

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
3 feet, 6 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
1.71 cal/cm2
Arc Flash Boundary
22
Working Distance
18 inches
Arc Flash PPE Level
1
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
In office room 006 behind the panel
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
B6 lobby
Fire Extinguisher Location
At the front door
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
Distractions/interruptions
Individual Capabilities
Human Nature
Stress (limits attention), Habit patterns
Error Precursor Mitigations
Keep on task don’t rush.

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