LBNL Qualified Electrical Worker Form
You have indicated that you would like to become a Qualified Electrical Worker (QEW) for the purposes of working at the Berkeley Lab.
Hazardous electrical work may only be performed by a lab Qualified Electrical Worker (QEW). Hazardous electrical work is defined as any work that causes any part of your body to come closer than 3.5 feet to exposed voltages 50V AC or DC or greater, with current 5mA or greater, or to capacitors (energy greater than 1 Joule if 50V or greater; 1000 Joules if less than 50V). This includes testing, diagnosing, maintaining, repairing and inspecting of energized apparatus and equipment; and work on electrical power distribution systems. This also includes verification of zero electrical energy for Lockout/Tagout.
The first step in this process is to tell us a little about your past experience as an electrical worker by filling out this form. The Electrical Safety Group (Stephanie Collins x4914 or Mark Scott x4694) will review it and provide feedback. A meeting to discuss might need to be set up.
Please remember, you are NOT qualified for this work until you have been formally authorized by ESG and by your Work Lead. Once authorized, you will be added to the Lab QEW work group which will trigger training requirements on your JHA.
Name (Last name, First name)
Electrician (State Certified or Journeymen)
Computing Sciences Directorate
Environmental Energy Technologies
Genomics West Bldg. 84
Tell Us About the Electrical Work You Will be Performing
Pick the drop down and check marks that BEST describe the electrical work that you will be performing.
1a. Type of equipment
Facilities fixed electrical equipment
Cord and plug equipment (less than 100 amps)
Cord and plug equipment (more than 100 amps)
Fixed R&D Equipment
1b. Other (if applicable)
2a. Electrical Work
Check the electrical work which you perform:
2b. Other (if applicable)
Check the voltages in which you will be exposed to:
Less than 50V AC
Less than 50V DC
120V AC cord and plug equipment
277V AC Lighting
1kV to 15kV AC Distribution
Greater than 1kV DC R&D Equipment
3b. Other (if applicable)
Summary of job tasks requiring electrical work
Summary of Skills & Knowledge
Please include attachments that explain your work experience and/or educational background pertaining to electrical systems and equipment and the voltages you have experience with. This can be a resume listing the electrical work you've performed and the voltages you've worked with, a list of work experiences including your years of background for each experience, certifications or licenses from previous employers, unofficial transcripts from educational institutions, a copy of your electrical or electronics diploma, a professional certification, a DD214, etc. If you have questions on what will be accepted, please contact x4914.
In addition, upload a copy of your job description.
Please do not submit documents that show Protected Identifiable Information (PII) such as your social security number, drivers license number or California state ID number. Make sure these numbers are blanked out on the documents you submit.
Note: up to 10 attachments can be included in the "File Attachments" section below.
Send me a copy of my responses
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