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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 3/21/2023 11:46:11
JSP ID: 773
Scope of Work: Troubleshoot/repair controller for roll up door at building 6

General Information

Work Order
W0315365
Building
-
Person in Charge
AndrewSouthward
Lead / Supervisor
Hendrick, Jeffery
Logged Email
amsouthward@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 2 - Energized Diagnostics
☑ Testing and Troubleshooting
☑ Visual Inspection
QEW Level
QEW 2
Second Person Requirement
Not Required
Second Person Identified
Avery Turner
Other Participants
Affected Persons Notified
N/A

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
120 test power from cord
System Information Review
☑ Panel Schedules
Control of Hazardous Energy
Exclusive Control of Plug
Equipment Condition
☑ Properly installed
☑ 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
Establish safe work area in shop, supply test power to controller, verify proper operation and voltages

Control of Work Area

Minimum Approach Boundary
42
Barricade Tape / Attendant
Danger - Red

Shock Risk Assessment

System Voltage
120 Vac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
3 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
Na cal/cm2
Arc Flash Boundary
Na
Working Distance
No Arc Flash Hazard Present
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
76-135
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
On hand
Fire Extinguisher Location
76-129
Contact Release Method Available and Tested
Voltage gloves

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
None

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:
  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 2026.03.17.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov