At one of our X-ray beamlines, an NSLS technician needed to work on a photon beam position monitor to replace the water hoses as part of a routine maintenance activity. There was an initial difficulty in identifying the responsible person for the component. Finally, believing the equipment to be managed by the PRT, the technician sought help in accessing the unit from the beamline Local Contact who assisted in the removal of the faceplate. Neither the local contact nor the technician were knowledgeable of the electrical hazards within the component and when the technician began his work, he received a 300 volts, 20 mA shock across his shoulders from a DC power supply that had not been secured. The technician was not injured. The incident was reported and a detailed investigation was conducted.
Lessons Learned (pdf)