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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 2/4/2026 9:03:30
JSP ID: 4516
Scope of Work: Pm for 92-HP-101, 92-HP-102 & 92-HP-103

General Information

Work Order
W0480308, W0480310 & W0480312
Building
92
Person in Charge
Gerald Fowler
Lead / Supervisor
Delgado, Alex
Logged Email
gdfowler@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
Darren kranz
Other Participants
Affected Persons Notified

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
E700A1A4A/92-HP- 101, 102 & 103
System Information Review
☑ 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
Place unit in a Loto safe condition then perform the pm.

Control of Work Area

Minimum Approach Boundary
42 inches
Barricade Tape / Attendant

Shock Risk Assessment

System Voltage
277/480 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
.31, .28 & .24 cal cn2 cal/cm2
Arc Flash Boundary
9 inches
Working Distance
18 inches
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
Elevator lobby 5th floor
Emergency Number to Call
510-486-6999/7911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Elevator lobby 5th floor
Fire Extinguisher Location
Same room
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
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
None

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