Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
undefined
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Equipment Name
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Asset Identification:
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Building
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Room
Lockout Procedure
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The authorized employee or supervisor must notify people affected by a shutdown that a loss of service will occur and provide the expected start and duration of the project and a description of all systems shutdown. Sufficient lead time should be provided to allow affected areas to prepare for shutdown.
Lockout Procedure
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Required Personal Protective Equipment:
- Safety Glasses
- Nitrile Gloves
- Latex Gloves
- Electrical Gloves
- Leather Gloves
- Arc Rated Clothing
- Arc Rated Hard Hat and Faceshield
- Hard Hat
- Hearing Protection
- Face Shield
- Arm Sleeves
- Tyvek Coverall
- Arc Flash Suit
- Safety Toe Boots
- Other (Provide Details)
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Additional PPE Details:
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Picture of Isolation Location
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Describe location of isolation point.
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Type of Energy
- Electricity
- Steam
- Water
- Gas
- Air Pressure
- Hydraulic
- Gravity
- Other (Must Enter in Details Below)
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If Other, Provide Details:
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Equipment Needed
- Lock
- Hasp
- Cable Lock
- Gate Valve Cover
- Butterfly Lockout
- Ball Valve Lockout
- Breaker Lockout
- Universal Valve Lockout
- Other (Provide Additional Details)
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If Other, Provide Details:
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Directions for locking isolation point:
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Method for verifying isolation:
Returning to Service
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When returning equipment to services, verify that all tools, equipment, and other objects are removed from the work area. Notify all authorized and affected employees of impending start-up. Remove locks and open isolation points in reverse order. Reactivate equipment according to established start up procedure.