Time / Date: 1/30/2023 7:09:38
JSP ID: 526
Scope of Work: Bldg 64C QEW Escort Support Maintain Safe Work Area for FATSP Painters
Work Order: W0310686
Building:
Person in Charge: Joseph Pica
Lead / Supervisor: Cameron, Benjamin
Logged Email: josephpica@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Not Required
Second Person Identified: Escort Painters
List Other Participants: Painters
Affected Persons Notified: Yes
Switching: No Switching Required
Panel / Equipment ID: Bldg 64C
System Information Review: Single Line Drawing, Panel Schedules, Arc Flash Labels, Perimeter Boundaries
Control of Hazardous Energy: Exclusive Control of Plug
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.

-Initial Bldg 64C Walkthrough -Brief Painters regarding Access and Work Boundaries -Alert Workers if any SubStation conditions effect Job Scope

Control of Work Area

Minimum Approach Boundary: 42inches plus
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: No Shock Hazard Present
Limited Approach Boundary: Make Safe per Scope
Restricted Approach Boundary: 3 feet, 6 inches
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: Not Applicable cal/cm2
Arc Flash Boundary: None
Working Distance: Outside of Scope
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures: Not Required

Capacitor Hazards

Capacitor Bus Voltage: Not Applicable
Capacitor total stored energy (joules): None
Discharge wait time (minutes): N/A

Emergency Response Plan

Nearest Landline Location: Substation
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Crew Carry
Fire Extinguisher Location: Substation and alleyway
Contact release method available and tested: Upstream breaker or switch, Outside of Job Scope

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment, Non QEW personnel in Vicinity

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities: Unfamiliar with, or first time performing task
Human Nature: Assumptions, Complacency/overconfidence
Error Precursor Mitigations:

Ensure Painters Identify Intentions Prior to Execution

PPE Inspections

Notes / Other

Brief Participants and Maintain Open Lines of Communication

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