ABS Systems, Inc. Lock Out / Tag Out Permit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Purpose

• This procedure establishes the minimum requirements for lockout tagout of elecgtrical energy sources. It is to be used to ensure that conductors and circuit parts are disconnected from sources of electrical energy, locked, tagged, and tested prior to engaging in work activities.

Instruction

• All employees shall be instructed in the ABS Systems, Inc. lockout tagout procedures.

Responsibility

• All persons installing a lockout device shall sign their names and the date on the tag to verify who is in charge of the lockout device and corresponding control of potentially hazardous situation.

Preparation

• Review of diagrammatic drawings, labels, tags, signs and all disconnecting means to determine that all possible means for circuit energization are accounted for. Including, but not limited to, emergency generator systems, battery backup supplies (UPS – uninterrupted power supply). Voltage testing tools and detectors are available to verify circuit is deenergized. Task lighting needed during deenergized work.

Communication

• All employees shall communicate with one another about the lockout tagout of circuits. This shall be accomplished verbally or written and shall include the competent person.

Rules for "Simple" Lockout Permits (Requires "qualified" authorization only)

• The qualified employee shall be knowledgeable of the circuit, system and energy that are being locked out.

• The energized electrical supply shall be deenergized and disconnected.

• The disconnecting means shall be locked and tagged out.

• An attempt to operate the disconnecting means shall be conducted to ensure operation is prohibited through the locked and tagged electrical supply or system.

• Voltage testing instrument shall be used to verify the electrical supply or system is actually deenergized.(Prior to this step, ensure voltage testing instrument is working properly)

Rules for "Complex" Lockout Permits (Requires management authorization)

• In complex situations, such as multiple crews, shifts or unique equipment design, additional preplanning and a written Job Activity Hazard Analysis shall be conducted prior to engaging in electrical system work. A qualified person, in charge shall be appointed to assume the role of organizing a safe and methodical process for deenergizing and locking out the complex situation. A complex lockout tagout system shall include at a minimum the following equipment:

• Lockout hasps to accommodate multiple lock shackles

• Tags designed to write personnel names, dates and general remarks

• Locks keyed individually with numbers stamped on keys and written on locks

• Log sheet of lockout tagout administration for tracking: location of lockout tagout, list of names, competent person(s), dates, and other general data as required per site specific requirements.

Restoring Electrical Supply

• Visually inspect task area for misplaced tools, debris, equipment parts such as: a. Screws b. Nuts c. Bolts d. Washers e. Lugs f. Breaker parts such as bolt on “fingers”

• Perform appropriate housekeeping to the task area.

• Remove lockout tagout devices by the person who installed them, or the overseeing competent person

• Notify all employees and other personnel involved with the task that the lockout tagout is removed, and to remain clear of the equipment and electrical supply.

• Return the disconnecting means to their normal condition.

• Verify all equipment and electrical system is operating normally using NFPA 70E compliant methods and DJQE approved digital multimeters or similar testing instruments.

Lockout permit

• Action Steps (BEFORE THIS PERMIT IS APPROVED, THE AREA MUST BE INSPECTED TO ASSURE THAT THE FOLLOWING INSTRUCTIONS HAVE BEEN FOLLOWED AND COMPLETED.)

• Have all operating controls been turned off?

  Yes

  No

  N/A

• Have all breakers or disconnects mechanisms that service the equipment been turned off?

  Yes

  No

  N/A

• Has the employees's padlock been fixed to the breaker or disconnect mechanism?

  Yes

  No

  N/A

• Has the start control been tested to ensure the correct breaker or disconnect mechanism was shut off and locked out?

  Yes

  No

  N/A

• Has all residual or stored energy in pneumatic, hydraulic, spring, or other mechanisms been relieved, disconnected, and/or blocked?

  Yes

  No

  N/A

• Have all manual valves on piping that could cause a hazard been closed or locked out to ensure that the residual pressure on the line was relieved? (Note: Automatic valves should never be used for isolation purposes.)

  Yes

  No

  N/A

• Have all mechanisms under tension or pressure from mechanical means or gravity pressure been released or firmly blocked?

  Yes

  No

  N/A

• Are other permits (Hot Work, Confined Space Entry, Radiation, or other hazards) needed?

  Yes

  No

  N/A

Lockout Information

• What type of Lockout Permit will this be?

  SIMPLE

  COMPLEX

• Describe the equipment to be locked out, the names of workers involved and the means of accomplishing this safety procedure. (Provide as much detail as possible)

• Provide pictures of the lockout and equipment affected.

  Media

Managers Name (Project Manager or Safety Specialist only)

• Managers Name

  Sign

Employee Name (With your signature below you attest that you are trained and "qualified" to perform DJQE Lockout Procedures)

• Employee Name

  Sign

• Employee Name

  Sign

• Employee Name

  Sign

• Employee Name

  Sign

• Employee Name

  Sign

• Employee Name

  Sign