Time / Date: 10/14/2022 10:28:17
JSP ID: 91
Scope of Work: M/M troubleshoot and repair lights in lab 74-0299
Work Order: 299670
Building:
Person in Charge: Shane Miller
Lead / Supervisor: Secheck, Stephen
Logged Email: spmiller@lbl.gov
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Standby Person
Second Person Identified: Nick Gripe
List Other Participants: Alex Lopez, Chris Neilson, Nick Gripe
Affected Persons Notified:
Switching: Non-Hazardous Switching
Panel / Equipment ID: 474A3A63A ckt 8,10,12,16.
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Complex LOTO (requires LP, CLP, FLP)
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.

Dawn the proper PPE,LOTO @panel474A3A63A ckt 8,10,12,16 under FLP-230.ZVV at switch box. Test wiring to locate abandoned switch leg to several lights that where out. Confirm switch leg and tie to existing switch. Close up switch box. Release LOTO and test switch

Control of Work Area

Minimum Approach Boundary:
Barricade Tape / Attendant:

Shock Risk Assessment

System Voltage: 120/208 V ac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: Avoid contact
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: .24 cal cal/cm2
Arc Flash Boundary: 7”
Working Distance: Avoid contact
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: Desk outside electrical room
Emergency Number to Call: X6999
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On cart
Fire Extinguisher Location: Hallway
Contact release method available and tested:

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

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