Kings Oil Tools Hazardous Energy Control

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Authorized employee

• Equipment being locked and tagged

Certification review

• 1.Have all affected employees been informed of work to be performed?

  Yes

  No

  N/A

• 2. Has equipment/system been shut down with controls in the off or neutral position?

  Yes

  No

  N/A

• 3. Has all hazardous energies associated with the equipment been identified and properly de-energized?

  Yes

  No

  N/A

• 4. Has every isolation point been blocked,locked,and tag?

  Yes

  No

  N/A

• 5. Do all tags contain the required information?

  Yes

  No

  N/A

• 6. Was a restart of the equipment tried prior to beginning work?

  Yes

  No

  N/A

Start up

• 7. World blocks locks and tags removed before attempting to restart equipment?

  Yes

  No

  N/A

• 8. Did personnel verify that equipment was safe to restart/operate?

  Yes

  No

  N/A

• 9. Was there a verification that all personnel were clear of machinery/equipment prior to restart?

  Yes

  No

  N/A

• 10. Was equipment returned to normal operation?

  Yes

  No

  N/A

• Add signature

  Sign