Template for control of hazardous energy procedure. Ttool c sample lockouttagout safety permitool c sample lockouttagout safety permit safety permit permit issued to. The goal of this document is to assist employers in developing and implementing machinespecific. The lock shall have the individual workers name and other identification. Keep other safe make sure everyone is clear of the equipment before starting. On the next page, fill out the information you want to see on your tags. For either exception, no work may be performed under the lockout until the lockout is complete and the group lockout master lock and orange master lock tag are. Osha lockouttagout assessment worksheet selfexplanatory assessment worksheet from osha. Developing and implementing a departmentspecific loto program. Use this form to document an inspection of a written lockout or tagout procedure. Failure to follow proper lockout tag out procedures may result in disciplinary action up to and. Departments are responsible for adopting and implementing this control of hazardous energy program lockouttagout.
The best way to ensure compliance with oshas control of hazardous energy lockout tagout regulatory standard is by creating a robust lockout tagout program that. Lockout tagout form in word and pdf formats toggle navigation. A loto procedure is a formal document detailing all the steps required to establish the lockout. When locking out, you only have to lockout the main electrical system. All maintenance personnel shall be provided with a good lock.
Lockouttagout lockout energy source isolation placards document and show visual procedures to control, isolate, and lockout energy sources as required by osha. Manual section labels for lockouttagout written program. As required by the occupational safety and health administration osha standard 29. The way to complete the online machine specific lockout tagout procedure template on the internet. Notify production supervisor and all affected personnel. A system, in which a lock, when properly attached to a power or energy source, prevents the unintentional activation of equipment. A sample lockout tagout procedure a good lockout tagout procedure, at a minimum, should contain the following elements. Supervisor and employee lockouttagout annual evaluation. Topic title organizationgrantee year grant number language. Lockout tagout template form pdf chargeless manuals base lockout tagout form template340270. Existing loto procedures are acceptable until fy16, after which they must be converted to the standard format in the lockouttagout loto procedure template. Lockout and tagout policy for enter company name purpose.
Permit required confined space vs non permit required what are sample lockout tagout form template unique doc xls letter template uower. A sample lockouttagout procedure a good lockouttagout procedure, at a minimum, should contain the following elements. Users must revise this generic form as necessary to fit their operations. All affected and other employees working in or entering work areas where lockout tagout is performed must be trained.
A list of procedures, abbreviated as loto, designed and. Fill in the blanks and tables with appropriate information. Lockouttagout loto procedure template electrical safety. They do not provide they physical restraint of a lock. This procedure establishes the minimum requirements for the lockout tagout of energy isolating devices whenever maintenance or servicing is done on machines or equipment where employees may be exposed to.
Control of hazardous energy procedure lockouttagout in accordance with wisconsin safety and professional services chapter sps 332 and osha 29 cfr 1910. This form is made to print and fill out by hand for those not comfortable filling it out on the computer. All berkeley lab loto procedures must follow the standard format included in the lockouttagout loto procedure template. Yes m no m na m was the procedure form properly filled out. The lock physically holds the switch or handle in the off position until it is removed by the authorized personnel. Do blanks need to be installed prior to work activities. Learner feedback form 1 page offer letter for temporary parttime employee 1 page performance appraisal form template 8 pages.
Lockout tagout periodic inspection form template sitemate. Preventing chronic beryllium disease through exposure recognition and control. The purpose of this program is to prevent worker exposure to hazardous energy such as from unexpected energization, startup, or release of stored energy. Browse through our semiprinted templates below and choose the one that fits the bill. Only trained, authorized employees can lockout tagout. Purpose this policy is established to protect university employees from the serious injuries that could result from the unexpected release of hazardous energy while they are servicing machinery or equipment. Lockout tagout compliance kit contains the training materials, energy control plan, and forms required to implement a lockout tagout program and train employees. This document provides an over view of oshas control of hazardous energy standard along with a template for a basic written lockout tagout procedure. Appendix a periodic lockouttagout inspection form i. Present information in a standardized, yet customized, easytofollow format. Name of your company employees must understand and comply with the contractors energycontrol procedures. Each affected employee all employees other than authorized employees utilizing the lockouttagout procedure shall be instructed in the purpose and use of the lockouttagout procedure, and the prohibition of attempts to restart or reenergize machines or equipment that are locked out or tagged out. Employees are responsible to observe safety practices contained in the lockouttagout program and to point out unsafe. You can use this fillintheblank template, or develop your own form.
Equipment has been locked or tagged tagout plus per equipment procedure. Make sure they know the machine is going to be started. Employees authorized to perform lockout shall be certain as to which switch, valve, or other energy isolating devices apply to the equipment being locked out. Template printing lockout tagout procedures and tags. This procedure establishes the minimum requirements for the lockout of energy isolating devices whenever maintenance or servicing is done on machines or equipment. Once you have these lists, workers can select from the database when filling out a form or performing a lockout tagout so that your information is. Developing specific hazardous energy control procedures using the lockouttagout hazardous energy control procedure template. The lock shall have the individual workers name and other identification on it. Lockouttagout employee verification form continued 4. It shall be used to ensure that the machine or equipment is. Training is done to ensure that the purpose and function of the energy control program are understood by employees and that the knowledge and skills required for the safe application, usage, and removal of the energy controls are acquired by employees. Grantee materials by topic occupational safety and. Hazardous energy control lockouttagout program template. It should be expanded, personalized and tailored to your companies, places of business or worksites.
The following simple lockout procedure is provided to assist employers in developing. This document provides an over view of oshas control of hazardous energy standard along with a template for a basic written lockouttagout procedure. Machine specific lockout tagout procedure template fill. Not to be sold or published on for profit websites. Lockout tagout annual procedure inspection certification form. This is the basic lockout procedure that is provided by osha from 1910. Lockout tagout loto procedure template pub3000, chapter 18, work process n addresses loto procedures. It covers controlling hazardous energy associated with the service and maintenance of. The advanced tools of the editor will guide you through the editable pdf. Osha requires that employees be trained on lockout policies and procedures.
Lockouttagout fact sheet employees need to be trained to ensure that they know, understand, and follow the applicable provisions of the hazardous energy control procedure. To establish lockouttagout loto procedures that safeguard students, faculty and staff and contractors from the unexpected energizing or start up of machinery and equipment, or the release of hazardous energy during service or maintenance activities. Secure appropriate pictures to the loto specific instructions form. Control of hazardous energy equipmentspecific lockouttagout. Lockout tagouts are a key area for site and worker safety, and companies create strong and reliable loto programs for ensuring their teams and sites remain safe.