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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 2/18/2026 11:30:37
JSP ID: 4565
Scope of Work: Relocate lighting in stairwell 0192 for accessibility purposes.

General Information

Work Order
431183
Building
77
Person in Charge
Alejandro Lopez
Lead / Supervisor
Ramer, Robert
Logged Email
alopez2@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Safety Watch
Second Person Identified
Shane Miller
Other Participants
n/a
Affected Persons Notified
Yes

System / Equipment

Switching
Hazardous Switching
Panel / Equipment ID
E72A9B1A5A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
Equipment Condition
☑ Properly installed
☑ No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish
Apply simple LOTO to circuit E72A9B1A5A-5, ZVV and relocate light fixtures

Control of Work Area

Minimum Approach Boundary
42 inches
Barricade Tape / Attendant
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
No
Voltage Glove Class
0
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
8.23cals cal/cm2
Arc Flash Boundary
52 inches
Working Distance
18 inches
Arc Flash PPE Level
4
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
n/a
Capacitor Total Stored Energy (Joules)
n/a
Discharge Wait Time (Minutes)
n/a

Emergency Response Plan

Nearest Landline Location
Gabor's office across from mechanical room
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Second floor main corridor
Fire Extinguisher Location
Second floor main corridor
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
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
☑ Multimeter and other electrical test instruments

Notes / Other

none

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