Time / Date: 3/7/2023 9:15:30
JSP ID: 702
Scope of Work: Install AHU door interlocks and PMS control modifications to stop power to AHU fans when AHU doors are opened if AHU is running
Work Order:
Building:
Person in Charge: Ernie Jew
Lead / Supervisor: Grounds, Jeff
Logged Email: ejew@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: Not Required
Second Person Identified: NA
List Other Participants: AJ Palengan Ryan Buffington Adam Armstrong
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: UE600A - 10
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO w/ RI
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.

Notify control room operator Perform LOTO briefing Set up LOTO work zone with Warning tape and signage Turn off AHU 1 at BMS Open toggle type disconnect switch for TCP M3 power Apply RI LOTO lock and tag Verify ZVV at TCP M3 Have workers join LOTO Perform work Notify control room operator Release LOTO Close toggle type disconnect switch for TCP M3 power Place AHU 1 in AUTO at BMS Verify door interlocks function as planned Remove Warning tape and signage End of job

Control of Work Area

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

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 inches
Will the hands enter the RAB: No
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 1.2 cal/cm2
Arc Flash Boundary: 18"
Working Distance: No Arc Flash Hazard Present
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: NA
Capacitor total stored energy (joules): NA
Discharge wait time (minutes): NA

Emergency Response Plan

Nearest Landline Location: Container office
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 3rd floor hallway across from Men's room
Fire Extinguisher Location: On column next to scissor lift
Contact release method available and tested: Rescue hook

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands: Simultaneous or multiple tasks
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Possible multiple tasks. Call Jeff Grounds to take on other tasks

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 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