Time / Date: 10/13/2022 12:32:43
JSP ID: 89
Scope of Work: Test low voltage lighting relay panel
Work Order: 299670
Building:
Person in Charge: Christopher Nelson
Lead / Supervisor: Keusch, Justen
Logged Email: cnelson@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Standby Person
Second Person Identified: Alex lopez
List Other Participants: Alex Lopez
Affected Persons Notified:
Switching: No Switching Required
Panel / Equipment ID: Watt Stopper panel fed from 47A3A63A circuit 14
System Information Review: Panel Schedules
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.

Donning proper PPE, inspect PPE, remove Lighting panel cover with inspected and tested meter check relays for incoming and outgoing voltages. Replace bad relay if found bad.

Control of Work Area

Minimum Approach Boundary: 42
Barricade Tape / Attendant: Warning

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

Arc Flash Risk Assessment

Incident Energy: 0.24 cal/cm2 cal/cm2
Arc Flash Boundary: 7 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
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: Room 209
Emergency Number to Call:
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location:
Fire Extinguisher Location: Outside room 223
Contact release method available and tested: Upstream breaker or switch

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands: Time pressure (in a hurry)
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Alex has to leave early we will not get in a hurry. We can always come back tomorrow

PPE Inspections

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