WORKPLACE INSPECTION NO 40: ISOLATION AND TAGGING

• Inspector:

• Supervisor:

• Company:

• Location:
  Address

• Date:

  Date

COMPLIANCE ACHIEVED

• Is the Isolation Work Instruction available and understood by staff?

  Yes

  No

  N/A

• Are "Lock Out" tags and locks and/or "Out of Service" tags in use?

  Yes

  No

  N/A

• Are "Lock Out" tags and locks and/or "Out of Service" tags filled out correctly?

  Yes

  No

  N/A

• Are spare “Lock Out” tags and “Out of Service” tags readily available?

  Yes

  No

  N/A

• Do all employees know the tag out procedures? (Check)

  Yes

  No

  N/A

• Do all employees use “Lock Out” tags and “Out of Service” tags correctly?

  Yes

  No

  N/A

• Are isolation locks, scissors and tags being used for all isolations?

  Yes

  No

  N/A

• Is moving plant fitted with isolator switches?

  Yes

  No

  N/A

• Are all isolation devices labelled?

  Yes

  No

  N/A

• Are keys removed from the isolation locks whilst personnel are working on the equipment?

  Yes

  No

  N/A

• Is there a copy of the "Lockout/Tagout Quick Reference Guide" available on site?

  Yes

  No

  N/A

Inspection Team

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign