EQUIPMENT LOCKOUT TAGOUT PROCEDURE

• Document No.

• Conducted on

  Date

• Facility

• Location
  Address

• Prepared by

• Personnel involved:

Lock Out Application Process

• 1. Notify affected personnel. 2. Properly shut down machine. 3. Isolate all energy sources. 4. Apply lockout devices, locks, tags and tags. 5. Verify the de-energisation of all energy sources.

PERSONS AFFECTED

• Affected Personnel

  Select Machine Operators, Maintenance Personnel, Visitors, Temporary workers, Contractors,

  • Machine Operators,
  • Maintenance Personnel,
  • Visitors,
  • Temporary workers,
  • Contractors,

ENERGY SOURCES INVOLVED

• Identify sources of energy

  Select Electric Main Electric Static Air (pneumatic) Hydraulic Gas Stored Energy Valves, Vents and Drains (oils, coolant, water, etc) Batteries or capacitors

  • Electric Main
  • Electric Static
  • Air (pneumatic)
  • Hydraulic
  • Gas
  • Stored Energy
  • Valves, Vents and Drains (oils, coolant, water, etc)
  • Batteries or capacitors

1. MACHINE TO BE ISOLATED & DETAILS

• Equipment ID# / Name

• Add media

  Media

• Description :

• Electrical Voltage

• Hydraulic Pressure while in operation:

• Air Pressure while in operation:

• Method of isolation for this machine

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Devices required to fully isolate:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

• Identify Lockout Points:

  Media

Lockout removal process

• 1. Remove all tools 2. Replace all guards and covers. 3. Notify all affected personnel 4. Check for all clear. 5. Re-energize per manufacturer or company procedure.

Signatures

• Add signature

  Sign