Tasman Power Entanglement and Crushing CCFV

• Site conducted

• Date and Time

  Date

• Task

• Work Location

• Conducted on

• Prepared by

Blocking and Maintenance Work

• 1. Is a procedure for the use of mechanical blocks (e.g. belt clamps, jacks,<br>stands etc) being followed?

  Yes

  No

  N/A

• 2. Are mechanical blocks appropriate for the task and safe for use? i.e. in<br>good condition, tagged, rated, with compliance/certification plates.

  Yes

  No

  N/A

Isolation and Verification of Zero Energy

• 3. Is an approved isolation procedure being followed?

  Yes

  No

  N/A

• 4. Are all personal locks on the correct isolation point?

  Yes

  No

  N/A

• 5. For un-isolated work (including testing and fault finding), is an approved<br>procedure being followed?

  Yes

  No

  N/A

• 6. Have all energy sources been identified, isolated and checked for zero<br>energy? E.g. process flows, mechanical, stored, residual, hydraulic,<br>pneumatic, chemical, electrical.

  Yes

  No

  N/A

Guards, Barriers and Barricades

• 7. Are guards, barriers and barricades appropriate, in place and secure?

  Yes

  No

  N/A

• 8. Are the location of emergency stops, pull wires and dead man switches<br>known and easily accessible?

  Yes

  No

  N/A

• 9. Are emergency stops, pull wires and dead man switches operational?

  Yes

  No

  N/A

• 10. Where guards, barriers and barricades have been removed, does the<br>work plan include their reinstalment?

  Yes

  No

  N/A

• 11. Are controls in place for any unguarded moving equipment? E.g.<br>maintaining safe distance, spotter, hard barricading, restricted access etc.

  Yes

  No

  N/A

Handling Requirements

• 12. Is clothing (including PPE) safe from entanglement with rotating/moving<br>equipment, including powered hand tools?

  Yes

  No

  N/A