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).
Work Order: n/a
Building:
Person in Charge: Felipe Sanchez
Lead / Supervisor: Other
Logged Email: fbsanchez@lbl.gov
Division: Facilities
QEW Level: QEW 1
Modes of Work: Mode 0 - Electrically Safe Work Condition
Second Person Requirement: Not Required
Second Person Identified: n/a
List Other Participants: n/a
Affected Persons Notified: N/A
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: No
Voltage Glove Class: Not Required
Will any other part of the body enter the RAB: No

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 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