Time / Date: 3/7/2023 9:52:00
JSP ID: 703
Scope of Work: Perform semi-annual Eaton UPS and battery P.M.
Work Order: N/A
Building:
Person in Charge: Ernie Jew
Lead / Supervisor: Grounds, Jeff
Logged Email: jtgrounds@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: Safety Watch
Second Person Identified: Jeff Grounds
List Other Participants: Eaton
Affected Persons Notified: Yes
Switching: Non-Hazardous Switching
Panel / Equipment ID: UE599
System Information Review: Single Line Drawing, 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.

1.Notify affected personnel of UPS maintenance period 2. PIC to perform job and LOTO briefing with Eaton workers 3. Perform bypass of Eaton UPS 1 and 2 and apply LOTO following written procedure attached to LOTO permits 4. Perform Work 5. PIC to perform re-energization briefing with Eaton workers 6. Notify affected personnel that UPS maintenance is complete and system will be returned to normal operation 7. Release LOTO and Eaton UPS bypass following written procedure attached to LOTO permits 8. Verify normal operation of Eaton UPS 1 and 2 9. Perform post job briefing for feedback and look for improvements to process 10. Job complete

Control of Work Area

Minimum Approach Boundary: 42"
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: 3.62 cal/cm2 (maximum) cal/cm2
Arc Flash Boundary: 35"
Working Distance: 18 inches
Arc Flash PPE Level: 1
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: 480V
Capacitor total stored energy (joules): N/A
Discharge wait time (minutes): N/A

Emergency Response Plan

Nearest Landline Location: Jeff's Office Container
Emergency Number to Call: 7911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: 3rd floor hallway adjacent to men's restroom
Fire Extinguisher Location: In UPS room
Contact release method available and tested: Rescue hook, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Lookalike equipment

Error Precursors

Task Demands: Critical steps or irreversible acts
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Second set of eyes

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