• Select date

Critical Questions

  • Does a written pre-plan exist?

  • Pre-plan number & title:

  • Is this a group or personal lock out?

  • Is the lockout log filled out for the group lockout?

  • One person,one lock and tag?

  • Are tags legible and clearly identify individual placing tag?

If NO is indicated then explain:

Authorized/qualified persons with locks placed on lock box/energy source:

Additional comments:

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