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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 2/19/2026 10:18:53
JSP ID: 4572
Scope of Work: Turn on circuit 9 on pnl 726a which feeds pnl726a9a

General Information

Work Order
WO475708
Building
ALS bldg 6
Person in Charge
Mayumi Taylor
Lead / Supervisor
Keusch, Justen
Logged Email
mjtaylor@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Standby Person
Second Person Identified
Robert Ralph
Other Participants
N/a
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
726a
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
☑ No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish
Wear appropriate PPE for the task and verify the proper condition and operation of all required PPE. Switch circuit breaker to the on position. Troubleshooting may require toggling breaker on and off.

Control of Work Area

Minimum Approach Boundary
42inches
Barricade Tape / Attendant
Warning - Orange

Shock Risk Assessment

System Voltage
120/208 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
0.40cal/cm2 cal/cm2
Arc Flash Boundary
10in
Working Distance
18 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
ALS sr2 door
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Bld6 lobby
Fire Extinguisher Location
ALS sr2 door
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient lighting, Wet location, Confined space, Insufficient/cramped/awkward space, Heavy traffic, Lookalike equipment, Noisy environment

Error Precursors

Task Demands
Simultaneous or multiple tasks, Repetitive actions or monotony, Critical steps or irreversible acts, Interpretation requirements
Work Environment
Distractions/interruptions, Changes/departures from routine, Unexpected equipment conditions
Individual Capabilities
Human Nature
Habit patterns, Assumptions, Complacency/overconfidence
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

N/a

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