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Lockout Tagout Procedures

The document provides lockout/tagout procedures for a specific machine or equipment, including a description and location, maintenance schedule, list of authorized and affected employees, energy sources, shutdown and start-up procedures, and method to verify isolation.

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Darrin Noble
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9 views

Lockout Tagout Procedures

The document provides lockout/tagout procedures for a specific machine or equipment, including a description and location, maintenance schedule, list of authorized and affected employees, energy sources, shutdown and start-up procedures, and method to verify isolation.

Uploaded by

Darrin Noble
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Attachment [number]

[Company name]

Lockout/Tagout Procedures for [machine/


equipment]

Description and location of machine/equipment: _________________________________________


_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Maintenance schedule:
Date Maintenance Task

List of authorized employees:


_______________________________ ____________________________________
_ ____________________________________
_______________________________ ____________________________________
_
_______________________________
_
List of affected employees:
_______________________________ ____________________________________
_ ____________________________________
_______________________________ ____________________________________
_
_______________________________
_
Energy source(s):
Energy Source Location Isolating Device Lockable Type of Lock/Tag
[type and [Yes/No]
magnitude]
Shutdown procedures (list specific steps, including method to dissipate or restrain):
1. [step]
2. [step]
3.

Start-up procedures:
1. [step]
2. [step]
3.

Method to verify isolation: ___________________________________________________________

Procedure approved by: _____________________________________________________________

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