DSB isolation of energy sources tags analysis

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

People

• Are workers appropriately trained and competent to complete the task?

  Yes

  No

  N/A

Procedures

• Is the construction pack located in accessible area?

  Yes

  No

  N/A

• Does the construction pack contain work methodology, jsea, isolation plan, and permit (if required)?

  Yes

  No

  N/A

• Have all the work crew signed the documents in the construction pack?

  Yes

  No

  N/A

• Have workers who maybe affected by the isolation made aware that it is in place?

  Yes

  No

  N/A

• Have the appropriate tag/s been placed on equipment, i.e. out of service tag or personal danger tag?

  Yes

  No

  N/A

Equipment

• Have all the energy sources been isolated, vented, purged?

  Yes

  No

  N/A

• Has it been confirmed isolations have been tested and isolations are effective?

  Yes

  No

  N/A

• Where applicable gasps and locks have been used?

  Yes

  No

  N/A

Site

• Reasonable practicable steps have been made to control tripping hazards?

  Yes

  No

  N/A

• Area has been left safe?

  Yes

  No

  N/A