Title Page
-
Line/Area
-
Machine Name/PF Number
-
Conducted on
-
Prepared by
-
Location
-
Personnel
- Lockout Step
-
Energy Type
- Electrical
- Pneumatic
- Inertia/Gravity
- Hydraulic
- Steam
- Water
- Mechanical
- Chemical
-
Energy Source Description
-
Lockout Point Location
-
Method/Lockout Device
-
Picture of Lockout Point
-
Is there any stored energy?
Type(s) of stored energy
-
Type(s) of stored energy
- Battery
- Capacitor
- Gravitational
- Flywheel
- Spring-Loaded
- Counter Weights
- Pressure
- Thermal
-
Method to dissipate/restrain
-
Picture
