Time / Date: 4/28/2023 9:19:41
JSP ID: 953
Scope of Work: Establish lotto
Work Order: 318670
Building:
Person in Charge: AJTurner2@lbl.com
Lead / Supervisor: Cameron, Benjamin
Logged Email: avery.turner08@icloud.com
Division: Facilities
QEW Level: QEW 2
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification
Second Person Requirement: Safety Watch
Second Person Identified: Joe Colmenares
List Other Participants: Avery Turner
Affected Persons Notified: Yes
Switching: Hazardous Switching
Panel / Equipment ID: E30a5a7a35a
System Information Review: Panel Schedules, Arc Flash Labels
Control of Hazardous Energy: Simple LOTO
Equipment Condition: Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish.

Establish lotto, ZVV and tags

Control of Work Area

Minimum Approach Boundary: 36
Barricade Tape / Attendant: 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: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 4.14 cal/cm2 cal/cm2
Arc Flash Boundary: 36 inches
Working Distance: 18 inches
Arc Flash PPE Level: 2
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: None
Capacitor total stored energy (joules): None
Discharge wait time (minutes): None

Emergency Response Plan

Nearest Landline Location:
Emergency Number to Call: Out side door
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: On-site
Fire Extinguisher Location: Hall way
Contact release method available and tested:

Environmental Conditions

Does the environment present additional hazards that should be addressed?

Wet location

Error Precursors

Task Demands:
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

None

PPE Inspections

Safety glasses (ANSI Z87),
Hearing protection,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Multimeter and other electrical test instruments

Notes / Other

None

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