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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 1/29/2026 8:43:38
JSP ID: 4501
Scope of Work: Switch Breaker 39 To Energize Panel 727A39A for Start up testing receptacles

General Information

Work Order
415062 ALSU Routine
Building
6 AlS Booster Roof Blocks
Person in Charge
Kevin Hope
Lead / Supervisor
Keusch, Justen
Logged Email
cnelson@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Christopher Nelson
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
727A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
Equipment Condition
☑ Properly installed
☑ Properly maintained
☑ All doors and covers closed and fully latched
☑ 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 from JSP inspect PPE and post warning tape and signs. Remove admin lock and tag. When Ready and it is clear switch Breaker 39 after we will have to fill out JSP for second panel switches and testing

Control of Work Area

Minimum Approach Boundary
42
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
3.61 cal/cm^2 cal/cm2
Arc Flash Boundary
33
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 pit below on rack by column 13 b
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
In b 6 lobby
Fire Extinguisher Location
At the bottom of the stairs to booster pit
Contact Release Method Available and Tested
Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Noisy environment

Error Precursors

Task Demands
Simultaneous or multiple tasks
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Keep on task and don’t let distractions get you away from your task

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

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