Scope of Work:troubleshoot lost power to three standard receptacles.
General Information
Work Order
314731
Building
-
Person in Charge
Jared Tissot
Lead / Supervisor
Secheck, Stephen
Logged Email
jtissot@lbl.gov
Division
Facilities
Work Planning
Modes of Work
☑ Mode 0 - Electrically Safe Work Condition ☑ Mode 1 - LOTO & Zero Voltage Verification
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
NA
Other Participants
NA
Affected Persons Notified
Yes
System / Equipment
Switching
Non-Hazardous Switching
Panel / Equipment ID
47A3A33A46A-19
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
preform voltage reading, switching loto and zvv. diagnose issue causing power loss. fix issue, restore power. test volatge
Control of Work Area
Minimum Approach Boundary
42 INCHES
Barricade Tape / Attendant
Shock Risk Assessment
System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
12 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
0.2 cal/cm2
Arc Flash Boundary
6 INCHES
Working Distance
18 inches
Arc Flash PPE Level
Minimum PPE for Electrical Work
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
74 229
Emergency Number to Call
7911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
B74 HALLWAY
Fire Extinguisher Location
229
Contact Release Method Available and Tested
Environmental Conditions
Does the environment present additional hazards that should be addressed?
None
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. ☑ 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)
