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QEW 1 / 2 / 3 Job Safety Plan

Electrical Safety
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Time / Date: 4/14/2023 10:28:49
JSP ID: 893
Scope of Work: Investigate the cause of the Lights that are OFF.

General Information

Work Order
322502
Building
-
Person in Charge
Anthony Pilz
Lead / Supervisor
Ramer, Robert
Logged Email
apilz@lbl.gov
Division
Facilities

Work Planning

Modes of Work
☑ Mode 0 - Electrically Safe Work Condition
QEW Level
QEW 2
Second Person Requirement
Safety Watch
Second Person Identified
Greg Neidiger
Other Participants
Affected Persons Notified
Yes

System / Equipment

Switching
Non-Hazardous Switching
Panel / Equipment ID
175A
System Information Review
☑ Panel Schedules
☑ Arc Flash Labels
Control of Hazardous Energy
LOTO Not Required (Mode 2 or 3 only)
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
Check The label for the circuit and panel. Then see the breakers labeled Overhead lights. Don PPE and switch the 120 single pole breakers ON.

Control of Work Area

Minimum Approach Boundary
50
Barricade Tape / Attendant
Attendant

Shock Risk Assessment

System Voltage
120/208 V ac
Limited Approach Boundary
42 inches
Restricted Approach Boundary
None
Will the hands enter the RAB
No
Voltage Glove Class
00
Will any other part of the body enter the RAB
No

Arc Flash Risk Assessment

Incident Energy
7.61 cal/cm2
Arc Flash Boundary
50
Working Distance
No Arc Flash Hazard Present
Arc Flash PPE Level
1
Incident Energy Reduction Measures
00

Capacitor Hazards

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

Emergency Response Plan

Nearest Landline Location
in building 60
Emergency Number to Call
Sufficient Cell Phone Signal
Yes
Clear Exit Path
Yes
AED Location
in building 60
Fire Extinguisher Location
in building 60
Contact Release Method Available and Tested

Environmental Conditions

Does the environment present additional hazards that should be addressed?
Insufficient lighting

Error Precursors

Task Demands
Work Environment
Individual Capabilities
Human Nature
Error Precursor Mitigations
Being Aware

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