Fatal Risk Critical Control Verification - Stored Energy

• Prepared by:

• Section:

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• Location:

• Date:

  Date

• Brief Description of Task/Activity

• Document Number:

• Make sure you know which Fatal Risks are present in your work area!

  

• If any fatal risk controls are not effectively implemented or maintained the task/activity should be stopped immediately and the related risks needs to be re assessed by a competent person.

Stored Energy

• These CRITICAL CONTROLS need to be in place to prevent exposure to stored energy.

  

• Does the activity present stored energy risks.

  Yes

  No

Competency

• Has the worker been trained and authorized, and does the worker understand the components of energy isolation?

  Yes

  No

  N/A

Energy Isolation/LOTOTO

• Have all energy sources been identified, isolated, and de-energized?

  Yes

  No

  N/A

• Have all isolation points been accounted for?

  Yes

  No

  N/A

• Are the workers using the appropriate locks/tags for the task performed?

  Yes

  No

  N/A

• Have locks, tags, and other isolation devices been installed so they cannot be bypassed or defeated?

  Yes

  No

  N/A

• Have all required employees locked out?

  Yes

  No

  N/A

• Has the tryout step been completed? Has "Zero Energy" been verified?

  Yes

  No

  N/A

Guards, Barriers, and Barricades

• Are guards, barriers, and barricades properly installed to protect personnel from uncontrolled energy release?

  Yes

  No

  N/A

• Are deadman switches, emergency stops, and pull cords confirmed as functional prior to work commencing?

  Yes

  No

  N/A

• Does the work plan address reinstallation of guards, barriers, and barricades prior to return to service.

  Yes

  No

  N/A

Sign off

• Person Conducted Fatal Risk Critical Control Verification.

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