QEW 1 / 2 / 3 Job Safety Plan

Time / Date: 3/25/2026 8:38:38

JSP ID: 4653

Scope of Work: 1. Nn hazardous switching 2.)Establish LOTO 3. Perform ZVV 3.Place HEC lock 4. Prime will demo receptacles. 5.) remove locks after work is complete 6.) Reenergize affected circuits.

General Information

Work Order

480713

Building

Person in Charge

Robert Ralph

Lead / Supervisor

Keusch, Justen

Logged Email

RobertRalph@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 1 - LOTO & Zero Voltage Verification

QEW Level

QEW 2

Second Person Requirement

Standby Person

Second Person Identified

Chris Nelson

Other Participants

Affected Persons Notified

Yes

System / Equipment

Switching

Non-Hazardous Switching

Panel / Equipment ID

595A40A

System Information Review

☑ Panel Schedules

Control of Hazardous Energy

Simple LOTO

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

1.notify affected parties. 2.) Open CB#1 3.) open CB#3 4. Establish LOTO for both . 5.) perform ZVV 6.) Tun over to contractor 7.) perform mode 0 work 8.) Reenergize circuits upon completion.

Control of Work Area

Minimum Approach Boundary

32”

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

Yes

Voltage Glove Class

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

3 cal. cal/cm2

Arc Flash Boundary

32”

Working Distance

18 inches

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

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

Next to panel

Fire Extinguisher Location

Next to panel

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

Everything is good

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan