Check List

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

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  • Is the task on the GM Approved Site Exclusive Control Register?

  • Is there an approved WIN/PMI for the task? (If No task cannot proceed and escalation is required)

  • Take 5 / JHA completed and a housekeeping check of the area conducted

  • Does Exclusive Control have to be set up to cordon off an area or an identified item of plant? (If No go to section 2)

  • What devices will best suit the setup? i.e. blue and white tape, chain or cones (Note: you may have to select more than one)

  • Is there more than one entrance point into the Exclusive Control Zone? If Yes ensure that a tag is attached to each potential entrance point identifying the designated entrance/control point as the "Sign On" point.

  • Is there a requirement to set up a "Drop Zone" within the Exclusive Control zone?

  • Is there a requirement for persons working within the area under Exclusive Control within or on the item of plant to also place their personal locks and tags onto relevant isolation points? (i.e. Crane Operators)

  • Does Exclusive Control have to be set up for an Isolation Point?

  • Is the isolation point to be energized or de-energised throughout Exclusive Control?

  • Is the isolation state going to change while under Exclusive Control? If Yes ensure that New Tag/Sheet is written up and signed off by all persons involved.

  • Will Exclusive Control be placed over an isolation point that has existing personal locks & tags? If Yes a Witness is required to check and confirm people on tag/sheet match those Locked on.

  • Will a Lockbox be placed under Exclusive Control? (When Exclusive Control is applied to a lockbox, an Exclusive Control tag and/or bag shall be placed on all relevant isolation and control points when an external source of energy is introduced)

  • Documentation requirements Exclusive Control Tag(s)

  • Exclusive Control Bag Tag

  • Exclusive Control Sheet

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.