Time / Date: 1/24/2023 13:11:05
JSP ID: 501
Scope of Work: Replace contactor in panel 208a fed by disconnect 16A.
Work Order: Training.
Building:
Person in Charge: Justin walker
Lead / Supervisor: Delgado, Alex
Logged Email: jwwalker@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Mike Rose
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: Disc. 16A.
System Information Review: Arc Flash Labels
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.

Define scope of work. Identify switching procedure. Perform shock hazard assessment. and arc flash hazard assessment. Determine proper ppe required to complete job assignment. Determine proper controls.determine type of switching. Determine type of loto. Determine 2nd person needed. Go over safety briefing. Contact affected individuals. Determine barricade and signage. Set up limited approach boundary. And barricades. Apply loto , verify ZVV. REplace contactor. Put equipment back together. Remove loto and verify zvv.

Control of Work Area

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

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: 2.37 cal/cm2 cal/cm2
Arc Flash Boundary: 26 inches.
Working Distance: 18 inches
Arc Flash PPE Level: 2
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: 75 back door phone in hall as you enter.
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 75A
Fire Extinguisher Location: 75A outside back door.
Contact release method available and tested: Upstream breaker or switch, 234A breakers 14, 16, and 18

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:

No current error precursors. Comfortable with job scope and in sound mind.

PPE Inspections

Notes / Other

Perform Job Breifing

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 2023.08.22.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov