CRM- Energy Isolation-Updated

• Prepared by

• Conducted on

  Date

• Shift

  Days

  Nights

• Day in rotation

  Select 1 2 3 4 5 6 7 8

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• Crew

  Select Crew 1 Crew 2 Crew 3 Crew 4 Straight Days Other

  • Crew 1
  • Crew 2
  • Crew 3
  • Crew 4
  • Straight Days
  • Other

• Department

  Select Ancillary Contractor Dewatering Maintenance Mill Mine Ore process Security Site admin Tech Services

  • Ancillary
  • Contractor
  • Dewatering
  • Maintenance
  • Mill
  • Mine
  • Ore process
  • Security
  • Site admin
  • Tech Services

• Which Maint group

  Select Fixed Electrical Mobile

  • Fixed
  • Electrical
  • Mobile

• Which group

  Select Dispatch IT Operations

  • Dispatch
  • IT
  • Operations

• Which group

  Select Met lab Pads Plants Refinery Projects

  • Met lab
  • Pads
  • Plants
  • Refinery
  • Projects

• Which group

  Select General Store Golf Course Day Care Hadley Maintenance Warehouse/Purchasing Clinic

  • General Store
  • Golf Course
  • Day Care
  • Hadley Maintenance
  • Warehouse/Purchasing
  • Clinic

• Which group

  Select Accounting CI Environmental HR Management Safety

  • Accounting
  • CI
  • Environmental
  • HR
  • Management
  • Safety

• Which group

  Select Assay lab Projects Survey Sampling Geotech Hydrology Geology Exploration

  • Assay lab
  • Projects
  • Survey
  • Sampling
  • Geotech
  • Hydrology
  • Geology
  • Exploration

• Which contracting group

• Location

  Truck shop verification

  Field verification

  During a PM

  PM or ALPM

Energy selection

• Please select the energy system you are verifying

  Select Maintenance work on a pressurized system Live testing

  • Maintenance work on a pressurized system
  • Live testing

• What location

  Truck shop verification

  Field verification

  During a PM

  PM or ALPM

TRAINING

• Can the tech communicate the steps for live testing

  Yes

  No

• Do you feel the training you received for energy isolation is adequate

  Yes

  No

• What is needed to make the training better

• What hazards has the employee identified and controlled on this job?

INSPECTIONS

• Are the components free from damage

  Yes

  No

• Has the equipment been deemed safe to operate

  Yes

  No

PROCEDURES

• Is the equipment in neutral and park brake applied

  Yes

  No

• Are all areas cleared prior to start up

  Yes

  No

  N/A

• Are the ball studs being checked

  Yes

  No

• Is the latest blue tooth technology being used to check movement on the ball studs

  Yes

  No

• Does this live testing task require the equipment to move

  Yes

  No

• Are barricades and/or spotters in place

  Yes

  No

• Is the barricading effective to keep people out of the area

  Yes

  No

COMMUNICATIONS (SIGNS AND BARRICADES)

• Is the live testing signage in place

  Yes

  No

• Are the personal isolation tags in place

  Yes

  No

• Are there only authorized personnel in the work area

  Yes

  No

• Are barricades in place to control entry

  Yes

  No

• Location

  Select Processing Plants Mill Dewatering Fixed Maintenance Maintenance Shops Leach Pads

  • Processing Plants
  • Mill
  • Dewatering
  • Fixed Maintenance
  • Maintenance Shops
  • Leach Pads

• Equipment

  Select Pumps (Carbon, solution, plant water/booster.) Carbon transfer system Fresh water system in the plant/Pad rinse Plant air (compressors.) Strip circuit, HX, vessel, discharge valves, blow-off Acid wash circuit, (caustic/nitric) Carbon truck pumps Floor sump pumps

  • Pumps (Carbon, solution, plant water/booster.)
  • Carbon transfer system
  • Fresh water system in the plant/Pad rinse
  • Plant air (compressors.)
  • Strip circuit, HX, vessel, discharge valves, blow-off
  • Acid wash circuit, (caustic/nitric)
  • Carbon truck pumps
  • Floor sump pumps

• Does the task involve stored energy? <br>(hydraulic, pneumatic, electric, mechanical, machinery, heat, gravity)

  Yes

  No

• Is maintenance being done on this system?

  Yes

  No

INSPECTIONS/PM

• Is this task PM work or corrective work?

  Task PM Work

  Corrective Work

• Is the PM work order with the worker?

  Yes

  No

• Is the PM being followed?

  Yes

  No

• STOP THE JOB!
  

  

• Have you applied energy isolation to any part of this task?

  Yes

  No

• Is there a documented WPE or FLRA for this work area?

  Yes

  No

• STOP THE JOB!
  

  

• STOP THE JOB!
  

  

• Have you applied energy isolation to any part of this task?

  Yes

  No

• Is there a documented WPE or FLRA for this work area?

  Yes

  No

• STOP THE JOB!
  

  

• STOP THE JOB!
  

  

TRAINING

• Have you worked on this system before?

  Yes

  No

• Has it been explained to you by a competent person, how to isolate the system

  Yes

  No

• Can the operator or mechanic explain the energy sources and controls in place for this task?

  Yes

  No

• What energy isolation controls have been put in place?

  Select LOTOTO Valve Isolation Drain Pressure Blocked

  • LOTOTO
  • Valve Isolation
  • Drain Pressure
  • Blocked

• Is there a better energy isolation system available for this task?

  Yes

  No

• Please describe

EXPERIENCE

• Is there a written standard for this task? <br>(SOP, Task Card, SWP, SPM, Manuel, PM, JHA, Cat SIS)

  Yes

  No

• STOP THE JOB AND DO A JHA!

  

• Is this task being completed at one of the ADR processing facilities?

  Yes

  No

• Is the work release form complete?

  Yes

  No

COMMUNICATION

• Has a GAPS conversation been discussed for this task

  Yes

  No

• Are barricades in use?

  Yes

  No

• Are the hazards clearly labeled?

  Yes

  No

• Are multiple pieces of equipment being locked out for this task?

  Yes

  No

• Is the lock out box form filled out and in place?

  Yes

  No

• What is the Goal, Risk and Plan for this task?

• Are barricades in use?

  Yes

  No

• Are the hazards clearly labeled?

  Yes

  No

• Are multiple pieces of equipment being locked out for this task?

  Yes

  No

• Is the lock out box form filled out and in place?

  Yes

  No