C/M or P/M
Reviewed:
Building & Room(s):
Project:
Scope of Work: Please list the scope of work in this area. (and remove these directions).
Tasks being Performed
This is a TEMPLATE
Please identify your scope of work
along with your means & methods to
complete your scope of work.
Such As;
-Roto hammering holes
-Installing uni-strut
-Installing Conduit
-Pulling wire
-Make up
-Start up
-Programming
Working on electrical < 50 volts
(Low voltage: No Permit Required )
Working on or near electrical > of work
50 volts
( LOTO Permit Required )
Working on or near Exposed
Energized parts
( EEWP Permit Required )
Employee Signatures:
A signed copy of this JHA must be posted while the applicable subcontractor is working on-site and be available to any LBNL employee upon request.
CONSTRUCTION JOB HAZARDS ANALYSIS
Contractor/Subcontractor Name:
Potential Safety Risks/Hazards
Risk of Shock, Electrocution or
Arc Flash
Risk of exposure to silica based
products
Risk of hitting unknown utilities.
Risk of injury from mechanical or a
release of unexpected hazards
Date:
Electrical Work
Rev: 2015
Date:
Safety Controls / Mitigations
You are required to LOTO All hazardous & potentially hazardous energy sources.
(This includes working On or Near, Exposed or Potentially exposed energy.)
An Approved LOTO permit or EEWP is Required before work begins.
Follow all details in the LOTO Permit or EEWP (Simple LOTO).
Multiple energy sources will be indentified (Complex LOTO) and Approved Equipment LOTO procedures may be
required. (Check with P/M in charge with this Project)
All LOTOs shall be Assisted & isolation of energy verified by LBL employees.
(unless otherwise noted per permit)
Procedures are to be Approved by Facilities prior to the start and release of LOTO.
Proper PPE shall be worn in accordance with All Permits, Procedures & Calculations.
LOTO permits are obtained at http://electricalsafety.lbl.gov
Half face respirators are required for rotohammering drilling into concrete.
Respirator Program with medical eval & fit test shall be submitted for review & acceptance by EH&S prior to the start
Ensure all Areas to be cored drilled have been scanned.
Follow Penetration Permit
Ensure all moving, rotating and potential hazards have been LOTOed prior to the start of work.
Ensure that All Pipes, Hoses, hydraulic rams & lines have been bleed & blocked(blanked) at Point of Operation.
Employee Signatures: Date: Employee Signatures: Date:
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