Lockout/Tagout Machine-Specific Procedure

• Location:

• Conducted on:

  Date

• Prepared by:

• Personnel involved (as applicable):

Machine Identification

• Machine Name

• Add media

  Media

• One piece of equipment or grouped similar equipment?

  One piece of equipment

  Grouped

• Location (i.e. Department)

• Manufacturer and Model #

• Serial Number or Company-specific Identifier

• Procedures must be machine-specific, meaning each piece of equipment must have its own procedure. More than one piece of equipment may share the same procedure only if they have the same hazardous energy sources and they have the same or similar methods for controlling that energy.

• Location(s) of all the pieces of equipment

• Serial Number or Company-specific identifier of each piece of equipment

Energy Sources

• Identify Sources of Energy

  Select Electrical Pneumatic Hydraulic Gas Thermal Gravity Chemical/Coolant Steam

  • Electrical
  • Pneumatic
  • Hydraulic
  • Gas
  • Thermal
  • Gravity
  • Chemical/Coolant
  • Steam

Lockout/Isolation Procedure

• (1) Notify all affected personnel who will be impacted by removing this equipment from service, such as maintenance personnel, operators, and supervisors. (2) If the equipment is operating, shut it down by the normal stopping procedure. (3) Isolate all energy sources. (4) Lockout energy isolating devices with an assigned individual lock(s). (5) Verify the de-energization of all energy sources. After ensuring that no personnel are exposed and as a check on having disconnected the energy sources, operate the push button or other normal operating controls to make certain the equipment will not operate. CAUTION: Return operating controls to neutral position after the test.

Step

• Describe the step:

• Add media

  Media

• Does this step require a lockout/tagout device?

  Yes

  No

• Location:

• Device(s) required:

  Select Individual Lock HASP and Locks Valve Lock Breaker Lock Plug Lock Chain & Lock Sign and Tag Lockout Box Controller Cover

  • Individual Lock
  • HASP and Locks
  • Valve Lock
  • Breaker Lock
  • Plug Lock
  • Chain & Lock
  • Sign and Tag
  • Lockout Box
  • Controller Cover

• Once all steps are completed, verify the de-energization of all energy sources. After ensuring that no personnel are exposed and as a check on having disconnected the energy sources, operate the push button or other normal operating controls to make certain the equipment will not operate. CAUTION: Return operating controls to neutral position after the test. Once verification is complete and operating controls are returned to neutral, maintenance/servicing task can be completed.

Restoring Equipment to Service

• When the job is complete and equipment is ready for testing or normal service, check the equipment area to see that no one is exposed. When equipment is clear, remove all locks. The energy-isolating devices may be operated to restore energy to the equipment.