Fatality Risk 'Control of Energy' - Critical Task Observation

• CTO completed on:

  Date

• CTO completed by:

• CTO location:

  Workshop - HME, ancillary, field

  CHPP - plant, workshop

  In field

• Specific location

• Number of people observed?

Critical Task Observation

• Equipment/plant being isolated?

  Mobile plant

  Fixed plant

• Type of isolation?

  Basic

  Complex

  Intermittent

• All energy source/s identified?

  Yes

  No

  N/A

• All energy source/s released & isolated/controlled?

  Yes

  No

  N/A

• All personnel involved in task have applied personal isolation locks to isolation point?

  Yes

  No

  N/A

• All energy source/s tested for dead/isolation verified?

  Yes

  No

  N/A

• Who verified isolation?

  First person to isolate only

  Subsequent person to lock onto equipment

  Group involved in initial stage of isolation

• Personal isolation locks uniquely keyed?

  Yes

  No

  N/A

• All personnel involved have current competency for Dawson basic isolation?

  Yes

  No

  N/A

• Complex isolator assigned to conduct isolation?

  Yes

  No

  N/A

• Complex isolator identified all energy source/s and isolation points to be isolated?

  Yes

  No

  N/A

• What reference was used by complex isolator to ensure all isolation points were identified?

  Work order/s

  Isolation matrix

  Procedure / Standard Task Instruction

  OEM manual

  Personal knowledge

• Complex isolator completes Group Isolation Sheet?

  Yes

  No

  N/A

• Complex isolator releases and isolates all identified energy source/s

  Yes

  No

  N/A

• Complex isolator places group lock & danger tag onto each identified isolation point?

  Yes

  No

  N/A

• Complex isolator verifies each isolation point against available information AND records each isolated point on Group Isolation Sheet?

  Yes

  No

  N/A

• Complex isolator places group lock keys inside lockbox and secures lockbox with own personal isolation lock?

  Yes

  No

  N/A

• Group Isolation Sheet attached / available with lockbox and signed by Complex isolator?

  Yes

  No

  N/A

• Complex isolator has current competency for complex isolation?

  Yes

  No

  N/A

• Personnel working under complex isolation confirm isolation with with Complex isolator prior to locking onto lockbox?

  Yes

  No

  N/A

• All personnel involved have current competency for Dawson basic isolation?

  Yes

  No

  N/A

• Work being done under intermittent isolation could not have been performed under full isolation?

  Yes

  No

  N/A

• An Intermittent Operations Permit has been completed for the task OR an STI exists for the task & is being followed?

  Yes

  No

  N/A

• One person is nominated as a 'Person in Charge' of intermittent operations?

  Yes

  No

  N/A

• Nominated 'Person in Charge' name is clearly displayed on boards?

  Yes

  No

  N/A

• Intermittent Operations signage clearly displayed on access to equipment?

  Yes

  No

  N/A

• Intermittent Operations tag placed on equipment controls?

  Yes

  No

  N/A

• All personnel involved in intermittent operations have locked onto sign/board/lockbox AND signed onto permit?

  Yes

  No

  N/A

• All personal locks uniquely keyed?

  Yes

  No

  N/A

• Clear communication process has been established for intermittent operations work?

  Yes

  No

  N/A

• All personnel are clear of equipment prior to start up AND start up controlled by nominated 'Person in Charge'

  Yes

  No

  N/A

• Nominated 'Person in Charge' last person to remove lock & confirms all clear before handing back?

  Yes

  No

  N/A

• All personnel involved have current competency for Dawson basic isolation?

  Yes

  No

  N/A

Other hazards / conditions / behaviours

• Any other minor hazards, conditions or unsafe behaviours identified?

  Yes

  No

  N/A