Time / Date: 3/21/2023 8:52:35
JSP ID: 771
Scope of Work: Switching Support for PMTs
Work Order: W0315386
Building:
Person in Charge: Joseph Colmenares
Lead / Supervisor: Hendrick, Jeffery
Logged Email: josephpica@yahoo.com
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Joseph Pica
List Other Participants: PMTs
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: 06 AHU 014 VFD via Panel 304A4Abkr9
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.

Permission Verification Stop B06 AHU 14 at VFD Secure VFD Lock VFD handle Confirm AHU Mechanically Safe PMTs Lock On Wait for Maintenance Completion Locks Removed Clear Area Switch Back Restore to Normal Check Operation

Control of Work Area

Minimum Approach Boundary: 52”
Barricade Tape / Attendant: Attendant

Shock Risk Assessment

System Voltage: No Shock Hazard Present
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: 6.9cal cal/cm2
Arc Flash Boundary: 52”
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: N/A
Capacitor total stored energy (joules): None
Discharge wait time (minutes): N/A

Emergency Response Plan

Nearest Landline Location: Elevator Hallway
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Crew Carry
Fire Extinguisher Location: Next Room at MCC
Contact release method available and tested: Upstream breaker or switch, Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Noisy environment, Mechanical Room

Error Precursors

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

Maintain Consistent Communication Use Verbatim Repeat Back

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

Notes / Other

Breaker feed Panel has 2011 Arc Flash Data No Provision for Current Survey available on site No Arc Flash Label at Local VFD or Local Disconnect Work Performed prior to office support personnel arriving/ answering phones

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