QEW 1 / 2 / 3 Job Safety Plan

Time / Date: 5/1/2023 6:33:36

JSP ID: 956

Scope of Work: Customer requested QEW support to provide LOTO (120Vac) to TSS technician (installation of UV light bulb inside fume hood).

General Information

Work Order

n/a

Building

Person in Charge

Felipe Sanchez

Lead / Supervisor

Other

Logged Email

fbsanchez@lbl.gov

Division

Facilities

Work Planning

Modes of Work

☑ Mode 0 - Electrically Safe Work Condition

QEW Level

QEW 1

Second Person Requirement

Not Required

Second Person Identified

n/a

Other Participants

n/a

Affected Persons Notified

N/A

System / Equipment

Switching

No Switching Required

Panel / Equipment ID

n/a

System Information Review

☑

Control of Hazardous Energy

Simple LOTO

Equipment Condition

☑ Properly installed

Sequence of Job Steps

List basic sequence of steps from start to finish

Informed customer and TSS technician the LOTO procedure needed for technician to accomplish his work. Checked outlet voltage (117.8Vac). I installed the LOTO equipment as per Berkeley Lab guideline. Advised TSS technician to start his work. I asked him if he will be doing wiring work on the main PCB control board. He said his procedure was to convert wires from old 5-wire terminations to a four-wire terminations. Informed him that per LBNL guideline, I will assume responsibility as a QEW to do the wiring job. After terminating the wires ( using wire-nuts and terminal lugs), I also help him troubleshoot the equipment. I removed the LOTO equipment. I let technician did his test. After a couple of test procedures, the UV light came back up.

Control of Work Area

Minimum Approach Boundary

n/a

Barricade Tape / Attendant

Shock Risk Assessment

System Voltage

120 Vac

Limited Approach Boundary

None

Restricted Approach Boundary

None

Will the hands enter the RAB

Voltage Glove Class

Not Required

Will any other part of the body enter the RAB

Arc Flash Risk Assessment

Incident Energy

n/a cal/cm2

Arc Flash Boundary

n/a

Working Distance

No Arc Flash Hazard Present

Arc Flash PPE Level

Minimum PPE for Electrical Work

Incident Energy Reduction Measures

Not Required

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

No landline available inside lab. room.

Emergency Number to Call

(510) 486-6999

Sufficient Cell Phone Signal

Yes

Clear Exit Path

Yes

AED Location

On-site

Fire Extinguisher Location

yes

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

n/a

PPE Inspections

☑ Safety glasses (ANSI Z87)
☑ Rubber insulating gloves and leather protectors
☑ Non-melting footwear that fully covers the feet
☑ Insulated tools
☑ Multimeter and other electrical test instruments

Notes / Other

n/a

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:

Detailed Scope of Work
Shock and arc flash hazards for each task
Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
Work area controls (barricades, signs, attendants)
Emergency Response Plan