LOCKOUT TAGOUT PROCEDURE

• Document No.

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• Conducted on

  Date
• Facility
  Address
• Location
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• Description
  Address

• Prepared by

• Personnel involved:

Photograph of plant / machinery

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Lock Out Application Process

• 1. Notify affected personnel. 2. Properly shut down machine. 3. Isolate all energy sources. 4. Apply lockout devices, locks, tags and tags. 5. Verify the de-energisation of all energy sources.

PERSONS AFFECTED

• Affected Personnel

  Select Machine Operators, Maintenance Personnel, Visitors, Temporary workers, Contractors,

  • Machine Operators,
  • Maintenance Personnel,
  • Visitors,
  • Temporary workers,
  • Contractors,

ENERGY SOURCES

• Identify sources of energy

  Select Electricity Mains Electricity Static Air (pneumatic) Hydraulic Gas Stored Energy Valves, Vents and Drains (oils, coolant, water, etc) Batteries or capacitors

  • Electricity Mains
  • Electricity Static
  • Air (pneumatic)
  • Hydraulic
  • Gas
  • Stored Energy
  • Valves, Vents and Drains (oils, coolant, water, etc)
  • Batteries or capacitors

1. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

2. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

3. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

4. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

5. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

6. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

7. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

8. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

9. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

10. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

11. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

12. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

13. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

14. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

15. ISOLATION DEVICES & DETAILS

• Add media

  Media

• Location and description :

• Method of isolation

  Select Valve lockoff Electrical isolation De-energise Key isolated and removed Fuse removal

  • Valve lockoff
  • Electrical isolation
  • De-energise
  • Key isolated and removed
  • Fuse removal

• Device required:

  Select Hasp and lock Valve Lock Breaker lock Plug lock Chain & Lock Sign and tag Lock out Box Controller cover

  • Hasp and lock
  • Valve Lock
  • Breaker lock
  • Plug lock
  • Chain & Lock
  • Sign and tag
  • Lock out Box
  • Controller cover

Lockout removal process

• 1. Notify affected personnel. 2. Properly shut down machine. 3. Isolate all energy sources. 4. Apply lockout devices, locks, tags and tags. 5. Verify the de-energisation of all energy sources.

Signatures

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  Sign

• Add signature

  Sign