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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 4/12/2023 9:17:28
JSP ID: 882
Scope of Work: LOTO and air gap motor for AHU 1

General Information

Work Order
W0318646
Building
-
Person in Charge
Andrew Southward
Lead / Supervisor
Cameron, Benjamin
Logged Email
alarmentaduran@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
Standby Person
Second Person Identified
Joe Colmenares
Other Participants
Alma Armenta
Affected Persons Notified
N/A

System / Equipment

Switching
No Switching Required
Panel / Equipment ID
215A5A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
Simple LOTO
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
Brief, LOTO, ZVV, air gap motor

Control of Work Area

Minimum Approach Boundary
27”
Barricade Tape / Attendant

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
No
Voltage Glove Class
0
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
2.24 cal cal/cm2
Arc Flash Boundary
27”
Working Distance
18 inches
Arc Flash PPE Level
1
Incident Energy Reduction Measures
0

Capacitor Hazards

Capacitor Bus Voltage
N/A
Capacitor Total Stored Energy (Joules)
N/A
Discharge Wait Time (Minutes)
N/A

Emergency Response Plan

Nearest Landline Location
Landline in hallway outside mechanical room
Emergency Number to Call
911
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
On hand
Fire Extinguisher Location
Outside mechanical room
Contact Release Method Available and Tested
Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient/cramped/awkward space

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

None

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