QEW 1 / 2 / 3 Job Safety Plan

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Time / Date: 3/1/2023 9:10:18

JSP ID: 658

Scope of Work: Shut off disconnect. LOTO. ZVV in unit panel. Perform work. Restore power. Check operations.

General Information

Work Order

310191

Building

Person in Charge

Justin Solis

Lead / Supervisor

Delgado, Alex

Logged Email

jrsolis@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

Darren Kranz

Other Participants

Affected Persons Notified

System / Equipment

Switching

Hazardous Switching

Panel / Equipment ID

112a6a1b1a-4/ac-37-55

System Information Review

☑

Control of Hazardous Energy

Simple LOTO

Equipment Condition

☑

Sequence of Job Steps

List basic sequence of steps from start to finish

Contact user. Shut off disconnect. LOTO. ZVV in unit panel. Perform work. Restore power. Check operations. Give feed back.

Control of Work Area

Minimum Approach Boundary

Barricade Tape / Attendant

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

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

0.12 cal/cm2

Arc Flash Boundary

Working Distance

18 inches

Arc Flash PPE Level

Incident Energy Reduction Measures

Capacitor Hazards

Capacitor Bus Voltage

Capacitor Total Stored Energy (Joules)

Discharge Wait Time (Minutes)

Emergency Response Plan

Nearest Landline Location

Room 227

Emergency Number to Call

7911

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

Portable

Fire Extinguisher Location

Outside room 226

Contact Release Method Available and Tested

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location, Lookalike equipment

Error Precursors

Task Demands

Work Environment

Individual Capabilities

Human Nature

Error Precursor Mitigations

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