Title Page

Do I Need HC/LOTO?

  • Do I perform active maintenance (adjustments, remove guards, change parts) on this machine where inadvertent start-up may cause injury or death?

  • You DO NOT need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged, you will need to use service/administrative locks and tags instead of LOTO.

  • Does this equipment meet the definition of exclusive control ( cord and plug with no potential for stored, residual energy), a single source of power, and can remain under continuous positive control of the worker while performing service or maintenance?

  • You DO NOT need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged, you will need to use service/administrative locks and tags instead of LOTO.

  • Has supervision determined the scope of work on this equipment to meet the following criteria?<br>Minor tool changes, adjustments, and servicing during normal operations provided: <br>- Such activities are routine, repetitive, and integral to use of the equipment. <br>- Work is done using alternative measures that provide effective worker protection.

  • You DO NOT need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged, you will need to use service/administrative locks and tags instead of LOTO.

  • Has supervision determined this equipment requires it to be energized for measuring, troubleshooting, and calibrations; taken in account there is no other safe way to conduct the needed work, and/or shutdown cannot be reasonably accomplished?

  • You DO NOT need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged, you will need to use service/administrative locks and tags instead of LOTO.

  • Is this work considered Hot Tap Operations, where you are working on transmission and distribution systems, such as gas, steam, water, or petroleum products and meet the following requirements?<br>- Supervisor or authorized worker demonstrate continuity of service is essential.<br>- System shutdown is impractical and documented procedures are in place and used.<br>- Appropriate PPE is used that will provide effective protection for workers.

  • You need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged and no longer under Active Maintenance then you will need to use service/administrative locks and tags instead of LOTO.

  • You DO NOT need a lockout tagout (LOTO) program for this machine. If the equipment is out of service or damaged, you will need to use service/administrative locks and tags instead of LOTO.

CONTROL OF HAZARDOUS ENERGY - MACHINE SPECIFIC PROCEDURE

Machine Information

  • Machine Name:

  • Machine Serial Number:

  • Machine Model Number

  • Machine Location

  • Select all the hazardous energy sources for the machine.

  • Location of ELECTRICAL 120 VOLT Disconnect/circuit breaker

  • Add media

  • Location of ELECTRICAL 240 VOLT Disconnect/circuit breaker

  • Add media

  • Location of ELECTRICAL 480 VOLT Disconnect/circuit breaker

  • Add media

  • Location of ELECTRICAL >600 VOLT Disconnect/circuit breaker

  • Add media

  • Location of COMPRESSED AIR Disconnect or shut off valve

  • Add media

  • Location of COMPRESSED GAS Disconnect or shut off valve

  • Add media

  • Location of THERMAL Disconnect or shut off valve

  • Add media

  • Location of STORED ENERGY (battery, capacitors-electrical) Disconnect, shut off valve, and bleed valve if applicable

  • Add media

  • Location of STORED ENERGY (hydraulic pressure) Disconnect, shut off valve, and bleed valve if applicable

  • Add media

  • Location of HYDRAULICS Disconnect, shut off valve, and bleed valve

  • Add media

  • Location of MECHANICAL Disconnect, shut off valve, safety blocks/braces, or machine locking mechanism

  • Add media

  • ARE THERE ANY OTHER ENERGY SOURCES THAT ARE NOT LISTED?

  • List them here and show how to shut them off.

  • Add media

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:

  • Add media

STEP 3 -- ISOLATE THE ENERGY SOURCES To ISOLATE the energy sources to the machine the AUTHORIZED EMPLOYEE must:

  • Add media

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:

  • Add media

STEP 5 -- RELEASE STORED ENERGY To RELEASE STORED ENERGY the AUTHORIZED EMPLOYEE must:

  • Add media

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:

  • Add media

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.

  • 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:

  • Restart Instructions:

STEP 10 -- MONITOR THE “MACHINE” OR “EQUIPMENT’S” OPERATION TO VERIFY IT IS OPERATING SAFELY.

DISCLAIMER It is the AUTHORIZED PERSONS responsibility to VERIFY to ensure that all energy sources have been isolated and all energy has been released PRIOR to performing any maintenance, repair, or work activities on the equipment. TS Safety Inc. assessors believe the information contained within this LOTO Machine Specific Instruction is correct at the time of printing. Please visit the OSHA website for additional safety compliance information.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.