Template Information
(v1.1.12012016) this written procedure form must be completed by any team member responsible for locking out or tagging out equipment.
Category: general
Template Questions
- This procedure establishes the minimum requirements for the lockout/tagout (LOTO) of hazardous energy
- Client / Owner
- Site Name
- Location at Site
- Project Description / Work Activities To Be Performed
- The following steps must be completed prior to beginning service and repair activities on equipment o
- These specific lockout/tagout procedures must include all equipment and/or systems which Authorized E
- EQUIPMENT / SYSTEMS
- Description of Equipment / System
- Photograph of Equipment / System
- SPECIFIC LOCKOUT/TAGOUT PROCEDURES
- Type of Energy
- Type & Location of Isolation Device
- Photograph of Isolation Device
- Type of LOTO Device(s) Required
- The following steps must be completed to remove LOTO devices after all service and repair activities
- Prepared By
- By signing this form, Authorized Employees agree that:1. I have read this Lockout/Tagout Written Proc
- Add additional signatures as necessary.
- Name / Date / Signature