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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 4/2/2026 8:40:49
JSP ID: 4678
Scope of Work: Switch off breakers 25,29,4,7,8,13,24,27 in panel 727A39A

General Information

Work Order
None
Building
6
Person in Charge
Tim Nguyen
Lead / Supervisor
Combs, Everett
Logged Email
tdnguyen@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
Kevin hope
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
727A39A
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
☑ Not energizing equipment for the first time
☑ or after electrical repair

Sequence of Job Steps

List basic sequence of steps from start to finish
Put on PPE Switch off 4,7,8,13,24,25,27,29

Control of Work Area

Minimum Approach Boundary
72
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
No Shock Hazard Present
Limited Approach Boundary
None
Restricted Approach Boundary
None
Will the hands enter the RAB
No
Voltage Glove Class
Not Required
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
0.13 cal/cm2
Arc Flash Boundary
5 in
Working Distance
18 inches
Arc Flash PPE Level
1
Incident Energy Reduction Measures
Not Required

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location
SR6
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
Building 6 front door
Fire Extinguisher Location
S0823
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient lighting, Insufficient/cramped/awkward space, Noisy environment

Error Precursors

Task Demands
Repetitive actions or monotony
Work Environment
Distractions/interruptions
Individual Capabilities
Human Nature
Mental shortcuts (biases)
Error Precursor Mitigations
Hand notes from lead

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

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