Title Page
CONTROL OF HAZARDOUS ENERGY - MACHINE SPECIFIC PROCEDURE
Machine Information
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Machine Name:
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Machine Serial Number:
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Machine Model Number
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Machine Location
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Select all the hazardous energy sources for the machine.
- Electrical 120 Volt
- Electrical 240 Volt
- Electrical 480 Volt
- Electrical >600 Volt
- Compressed Air
- Compressed Gas
- Thermal
- Stored Energy (battery, capacitors-electrical)
- Stored Energy (hydraulic pressure)
- Hydraulics
- Mechanical
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Location of ELECTRICAL 120 VOLT Disconnect/circuit breaker
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Location of ELECTRICAL 240 VOLT Disconnect/circuit breaker
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Location of ELECTRICAL 480 VOLT Disconnect/circuit breaker
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Location of ELECTRICAL >600 VOLT Disconnect/circuit breaker
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Location of COMPRESSED AIR Disconnect or shut off valve
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Location of COMPRESSED GAS Disconnect or shut off valve
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Location of THERMAL Disconnect or shut off valve
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Location of STORED ENERGY (battery, capacitors-electrical) Disconnect, shut off valve, and bleed valve if applicable
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Location of STORED ENERGY (hydraulic pressure) Disconnect, shut off valve, and bleed valve if applicable
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Location of HYDRAULICS Disconnect, shut off valve, and bleed valve
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Location of MECHANICAL Disconnect, shut off valve, safety blocks/braces, or machine locking mechanism
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ARE THERE ANY OTHER ENERGY SOURCES THAT ARE NOT LISTED?
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List them here and show how to shut them off.
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PURPOSE OF THIS PROCEDURE: This procedure establishes the minimum requirements for the lockout of energy isolating devices whenever maintenance or servicing is done on machines or equipment. It shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine or equipment or release of stored energy could cause injury.
ENFORCEMENT All employees are required to comply with the restrictions and limitations imposed upon them during the use of lockout tagout. The authorized employees are required to perform the lockout tagout in accordance with this procedure. Failure to follow lockout/tagout procedures will result in disciplinary action and/or termination of employment. The disciplinary procedures are maintained in the office.
STEP 1 -- NOTIFY ALL AFFECTED EMPLOYEES Ensure ALL EMPLOYEES are safely positioned away from Machine or Equipment. NOTIFY -ALL affected employees of the “Machine” shut down intentions.
STEP 2 -- SHUT DOWN To shut off or shut down the machine the AUTHORIZED EMPLOYEE must:
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STEP 3 -- ISOLATE THE ENERGY SOURCES To ISOLATE the energy sources to the machine the AUTHORIZED EMPLOYEE must:
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STEP 4 -- APPLY LOCKS AND TAGS TO ENERGY ISOLATION DEVICES ALL PERSONNEL WHOM WILL BE PERFORMING WORK ON THE MACHINE, DEVICE, OR SYSTEM, ARE REQUIRED TO PLACE THEIR OWN LOCKS AND TAGS ON THE ENERGY ISOLATION DEVICES. To APPLY ENERGY ISOLATION DEVICES the AUTHORIZED EMPLOYEE must:
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STEP 5 -- RELEASE STORED ENERGY To RELEASE STORED ENERGY the AUTHORIZED EMPLOYEE must:
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STEP 6 -- VERIFY THAT THE ENERGY HAS BEEN DEPLETED, RELEASED, OR BLED OFF To VERIFY ENERGY HAS BEEN DEPLETED, RELEASED, OR BLED OFF the AUTHORIZED EMPLOYEE must:
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STEP 7 -- PERFORM SERVICING, REPAIRS, OR MAINTENANCE ON THE MACHINE Testing or positioning of machines, equipment or components thereof. In situations in which lockout or tagout devices must be temporarily removed from the energy isolating device and the machine or equipment energized to test or position the machine, equipment or component thereof, the following sequence of actions shall be followed: 1. Clear the machine or equipment of tools and materials; 2. Remove employees from the machine or equipment area; 3. Remove the lockout or tagout devices; 4. Energize and proceed with testing or positioning; Do not place body parts in danger areas 5. De-energize all systems and reapply energy control measures to continue the servicing and/or maintenance as detailed in this procedure. Complete the assigned repairs, maintenance, or cleaning. If you need to restart the machine for troubleshooting remember to follow the LOTO instructions precisely. Do not release from LOTO until repairs or maintenance work has been completed.
STEP 8 -- TO RELEASE FROM LOCK OUT TAG OUT THE AUTHORIZED EMPLOYEE MUST: 1. Remove all tools/equipment used for the repair process. 2. Re-assemble the machine. 3. Re-Install all safe guards, machine guards, and safety devices that were removed or disconnected due to the maintenance or repair activities. 4. Ensure ALL EMPLOYEES are safely positioned (away from Machine) NOTIFY -ALL affected employees of the “Machine” re - start intentions. 5. Remove the Lockout/Tagout device that was attached to the ENERGY ISOLATION DEVICES. NOTE—only the person who applied the Lockout/Tagout Device may remove it. Ensure area is clear prior to restart.
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Locks and tags were installed on the following isolation devices and must be removed before proceeding:
STEP 9 -- RESTARTING THE MACHINE It is critical that the operator of this machine follow the detailed and explicit instructions provided by the manufacturer or the company for restart and operation of this machine. The following are basic restart procedures:
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Restart Instructions:
