Time / Date: 3/1/2023 8:35:06
JSP ID: 655
Scope of Work: Will be replacing exterior lights
Work Order: 312500
Building:
Person in Charge: Arnel Jugarap
Lead / Supervisor: Keusch, Justen
Logged Email: schea@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 0 - Electrically Safe Work Condition, Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Sayee Chea / Frank Hampton
List Other Participants:
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 217A1A1A
System Information Review: Panel Schedules, 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.

Setup the Boom Lift, notify customers, locate panel and Socket Breaker, secure area to keep people out, perform ZVV after applying LOTO, inspects 0 Voltage gloves, meter and tools, then replace light fixtures. Will inform customers after job is complete

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: 3.15 cal/cm2
Arc Flash Boundary: 33 Inches
Working Distance: 18 inches
Arc Flash PPE Level: Minimum PPE for Electrical Work
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: (510) 325-9027
Emergency Number to Call: (510) 486-7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Base of stairs room 123
Fire Extinguisher Location: Loading dock of room 150
Contact release method available and tested: Voltage gloves, Lower Boom Lift manually from the ground

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Heavy traffic, Fall hazard

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

NA

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,
Insulated tools,
Multimeter and other electrical test instruments

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