Location of Lockout/Tagout Equipment
Name of Equipment Being Controlled
Location of Equipment Being Controlled
Location of Start/Stop Control
Location of Energy Control Panel
Voltage Associate with Energy Control Panel
Other Purposes for LOTO:
Other Energy Sources to be Controlled
-NOTIFY ALL AFFECTED EMPLOYEES that application of lockout/tagout devices will be applied to this machine.
-SHUT DOWN MACHINE USING NORMAL SHUTDOWN PROCEDURES & APPLY LOCKOUT/TAGOUT DEVICE AS FOLLOWS:
-Clear machine or equipment of tools and materials.
-Notify all affected employees and remove all tools from equipment area.
-Employee(s) that applies the lockout/tagout shall remove the device(s).
Start the machine/equipment as follows:
Procedure to Start
Was this form used for employee authorization?