AC LO TO Program 1 PDF
AC LO TO Program 1 PDF
EMPLOYEE TRAINING
Employers must provide training and ensure that the purpose and function of the energy control program are understood by the employees
and that the employees have the knowledge and skills required for the safe application, use, and removal of the energy controls.
The training must include the following:
Each authorized employees will receive training in the recognition of applicable hazardous energy sources, the type and magnitude of the
energy available in the workplace, and the methods and means for energy isolation and control.
The Program Administrator is responsible for ensuring that instruction is given to each affected employee in the purpose and use of the
energy control procedure.
The Program Administrator is responsible for ensuring that instruction on lockout/tagout procedure is given to all other employees whose
work operations are in an area where energy control procedures are utilized. The instruction will include the prohibition relating to attempts
to restart or reenergize machines or equipment that are locked out or tagged out.
PROGRAM AUDIT
The Program Administrator or a designated employee will conduct documented periodic inspections of the energy control procedures to ensure
that the procedures and requirements of this program are being followed. An authorized employee other than the one(s) using the energy control
procedure must perform the inspection.
The Program Administrator or a designated employee performing the periodic inspection does not have to observe every authorized employee
implementing the energy control procedure on the machine or equipment on which he or she is authorized to perform servicing and maintenance.
The Program Administrator or designated employee participating in the review needs to:
1. Observe a representative number of authorized employees while they are implementing the procedure, and
2. Talk with all other authorized employees even though they may not be implementing the energy control procedure.
This review may be completed in one or more meetings in which all authorized employees (as well as affected employees) are in attendance to
review the specific energy control procedures.
When lockout is used for energy control, the periodic inspection will include a review between the inspector and each authorized employee, of
that employees responsibilities under the energy control procedure being inspected. When a tagout procedure is being inspected, a review on
the limitations of tags, in addition to the above requirements, must also be included with each affected and authorized employee.
Document and certify the inspection, using the Certificate of Inspection
Periodic Inspection of Energy Control Procedures Form, located in Appendix B. The certification will identify the machine or equipment on which
the energy control procedure was utilized, the date of the inspection, the employees included in the inspection, and the person performing the
inspection. The Program Administrator will maintain on file the inspection certification documents.
Location:
Machine Identification:
Manufacturer/Model Number:
Energy Sources
The energy sources present on this equipment are: (electrical, steam, hydraulic, pneumatic, natural gas, stored energy, etc.)
ENERGY SOURCE
LOCATION
Lockable
YES
NO
Type lock or
block needed
Shutdown Procedures
List the steps in order necessary to shut down and de-energize the equipment. Be specific. For stored energy, be specific about how
the energy is dissipated or restrained.
Procedure:
Lock Type & Location:
De-energized State To Be Verified? How?
NOTIFY ALL AFFECTED EMPLOYEES
Shutdown Procedures
List the steps in order necessary to reactivate (energize) the equipment. Be specific.
Procedure:
Energy Source Activated:
NOTIFY ALL AFFECTED EMPLOYEES
Date of Inspection:
Yes No
Yes No
3. Energy Identification
Yes No
4. Lockout Device
Yes No
5. Tagout Device
Yes No
Yes No
7. Lockout Steps
Yes No
Yes No
9. The inspection revealed the following problems and/or deviations between the energy control
program and the employees performance:
The following steps are recommended to correct problems identified above:
Certification: This energy control procedure is adequate (or modified as noted above).
Inspectors Signature:
Date:
Date:
Employee Name:
Print Name
Signature
Date of Training:
Employer/Location:
Instructor:
Training Received:
Contents of the Energy Control Program reviewed
Contents of energy control procedures for the following machines/equipment reviewed:
A uthorized employees were trained to recognize the applicable hazardous energy sources, the type and magnitude
of energy available, and the methods and means for energy isolation and control. Employees were instructed to
the limitations of tags.
E mployees were instructed how to recognize when lockout/tagout procedures are in effect and the purpose of, and
applicable hazards pertaining to the energy control procedures.
Date:
Print Name
Signature
Date:
Date: