Time / Date: 1/13/2023 12:25:32
JSP ID: 446
Scope of Work: Switch circuit 238A3A2A-26
Work Order: 309432
Building:
Person in Charge: Stephen Sechak
Lead / Supervisor: Secheck, Stephen
Logged Email: gcn@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Safety Watch
Second Person Identified: Greg Neidiger
List Other Participants:
Affected Persons Notified: N/A
Switching: Hazardous Switching
Panel / Equipment ID: 238A3A2A
System Information Review: Panel Schedules, Arc Flash Labels, FAEN
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly installed, Properly maintained, 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.

Don 40 cal suit, hood, gloves. Switch breaker while standing to the side

Control of Work Area

Minimum Approach Boundary:
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: No Shock Hazard Present
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 12 inches
Will the hands enter the RAB: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 1.8 @ 18in cal/cm2
Arc Flash Boundary: 23"
Working Distance: 24 inches
Arc Flash PPE Level: 2
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:
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 1st floor elevator lobby
Fire Extinguisher Location: just outside electrical room
Contact release method available and tested: no shock hazard

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Insufficient/cramped/awkward space

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

no error precusors

PPE Inspections

Notes / Other

Perform Job Breifing

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 2023.08.22.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov