Title Page
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Location of vessel (drydock or berth)
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Conducted on
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Prepared by
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Vessel / Facility Name
Forms Resources
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MIDD-PRD-013 (REV-2) LOTO WAF Form07.24.2023
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SWI-F-006 Lock Out Tag Out Instruction
MIDD LOTO WAF audit
Initial Request for LOTO
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Is the WAF request filled out properly?
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What was the discrepancy? (were false items entered to continue filling out WAF?)
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Use this WAF form for reference.
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What violation in SWI-F-006 Lock Out Tag Out Instruction MIDD LOTO was nonconforming?
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Paragraph number?
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24 hours from the time the WAF was requested to the time the LOTO was applied reasonable? (within 48-72 hours depending on the type of LOTO)
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Were the affected employees notified that the LOTO will be taking place?
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Who checked to ensure the control of Hazardous Energy?
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Was it the same person on the WAF the Authorized Employee that checked the "Control of Hazardous Energy"?
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Is this Group LOTO?
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Did all Authorized Employees involved check in with WAFCOR prior to LOTO application?
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What was the reason?
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Was the Group LOTO form "MIDD-PRD-015 (REV-2) Group Record List" properly filled out in its entirety?
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What was non-conforming?
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After WAFCOR processed the group & assigned a PAE for each, how did the PAE verify equipment/device was safe?
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Reference the WAFCOR log binder and verify by taking a pictures of the group LOTO application.
Tags & Locks
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How many points of isolation was determined?
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Was the lock(s) placed at the point of isolation?
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If the lock was placed before the point of isolation, where was it placed?
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Was the "Danger Tag" filled out in it's entirety?
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Was the tag placed on the shackle of the lock?
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Was this unlockable?
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Was the "Tags+" method used according to MIDD-SWI-F-006 Lock Out Tag Out Instruction 8.4 Use of Tags+?
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Refer to this section for clarification.
Testing & Positioning
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Was this WAF removed temporarily for op testing?
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Was WAFCOR notified 24 hours prior to testing?
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What was the reason for not notifying WAFCOR prior testing?
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Was there another authority giving direction to the Authorized Employee to remove LOTO?
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Who was it?
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Did the Authorized Employee remove the LOTO ?
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What was the reason?
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Was the MIDDPRD-016 Emergency Lock Removal Record properly filled out?
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show evidence of non-conformance through media type (pic or vid)
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Who was the Authorized Employee that temporarily removed the LOTO for op testing?
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Were the criteria met according to MIDD-SWI-F-006 Lock Out Tag Out Instruction 8.2.1 before ships force energized their equipment/machinery?
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What was non-conforming from MIDD-SWI-F-006 Lock Out Tag Out Instruction 8.2.1?
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MIDD-SWI-F-006 Lock Out Tag Out Instruction 8.2.1
Completing LOTO Removal & Re-Energizing
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When work was completed, did the AE/PAE initiate the removal for LOTO?
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Why wasn't it the Authorized Employee on the WAF?
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(if applicable) What was done in place of the Authorized Employee required participation?
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Was the MIDDPRD-016 Emergency Lock Removal Record properly filled out?
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Was LOTO ultimately removed?
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What was the discrepancy?
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What type of removal was it?
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Was WAFCOR notified to clear the WAF?
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What was the reason for not notifying WAFCOR prior to clearing the WAF?
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Was there another authority giving direction to the Authorized Employee to remove LOTO?
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Who was it?
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Was the WAF signed off properly when work was completed?
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What was done if work was completed but not signed off by the Authorized Employee?