• 1. Are all applicable legal requirements identified, maintained and complied with?

  • 2. Has an initial assessment of the workplace to identify tasks, machinery and equipment in which the energization of release energy could result in injury to workers been carried out?

  • 3. Have documented procedures for the control hazardous energy for each applicable piece of equipment been implemented?

  • 4. Is there a permit program to control work on line-breaking and work on chemical process systems and for which there is no specific hazardous energy control procedure?

  • 5. Is there an effective lock out process developed and implemented as per requirements?

  • 6. Is there an effective tag out process developed and implemented as per the requirements?

  • 7. In the absence of the possibility to lock out, is the tag out system managed correctly according to the requirements?

  • 8. Is re-energization of the machine or equipment managed in a manner that protects all personnel from injury (following completion of the task)?

  • 9. Are all precautions taken for removal of another person's lock and tag when the individuals is not on site (NOTE: it is not permissible to remove another person's lock while that person is still on site)?

  • 10. Are the energy isolation devices, including locks and tags durable and suited for their intended use?

  • 11. Are affected personnel whose work operations are/may be in an area where energy control procedures apply adequately trained with regard to hazardous energy control?

Comments

Recommendation & Evaluation

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.