ŠĻą”±į>ž’ SUž’’’R’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į5@ šæķbjbjĻ2Ļ2 _:­X­XĒ%’’’’’’ˆŠŠŠŠŠŠŠ$ōœ&œ&œ&Pģ&,'DōK3–h'h'(''''''},,,,-¬,¼/Ģ2$į4R37bš2Š©(''©(©(š2ŠŠ''3·*·*·*©(vА'А'},·*©(},·*Š·*‡+ć+BŠŠ5,'\' ą6 źu/Ēœ&)ā%,},30K3-,•7*”•75,ōōŠŠŠŠ•7Š5,H'"²'·*Ź'Ž'ː'''š2š2ōō¤˜•*"ōō˜ Written Lockout/Tagout Procedure (Department/Division) Last Updated: Type of Equipment: Location: ID# (if applicable): Work to be performed Employee(s) authorized perform this work: Purpose: This procedure establishes the minimum requirements for the lockout/tagout of energy-isolating devices whenever maintenance or servicing is done on the machine or equipment listed above. It shall be used to ensure that the machine/equipment is stopped, isolated from all potentially hazardous energy sources and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine or equipment or release of stored energy could cause injury. Compliance: All employees are required to comply with the restrictions and limitations imposed upon them during the use of lockout. Authorized employees are required to perform the lockout in accordance with this procedure. All personnel, upon observing a machine or piece of equipment that is locked out to perform servicing or maintenance, shall not attempt to start, energize or use that machine or equipment. Notice : Failure to comply with all parts of lockout/tagout procedures may result in immediate dismissal. Checklists: A checklist is / is not required to be completed each time this procedure is performed. (circle one) If required, appropriate checklists may be found Location Written description of required lockout/tagout procedures for the machine/equipment listed above LOCKOUT SEQUENCE Step 1. Notify all affected employees that servicing or maintenance is required on a machine or equipment and that the machine or equipment must be shut down and locked out to perform the servicing or maintenance. Affected Employees: Methods to use for notification: Step 2. The type and magnitude of the energy that the machine or equipment listed above involves, the hazards involved and the method of control that must be used to eliminate hazards are listed below. Type of Energy Hazard Method of Control Step 3. If the machine or equipment is operating, shut it down by the normal stopping procedure. Methods for shutting down the machine/equipment listed above: (List type & location of switch(es), valve(s), etc. and, if applicable, sequence that must be followed) Step 4. Engage the energy isolating device(s) so that the machine or equipment is isolated from the energy source(s). Isolation Device Location Isolation Method Step 5. Lock out the energy isolating device(s) with assigned individual lock(s). Step 6. Stored or residual energy (such as that in capacitors, springs, elevated machine members, rotating flywheels, hydraulic systems, and air, gas, steam, or water pressure, etc.) must be dissipated or restrained by methods such as grounding, repositioning, blocking, bleeding down, etc. Type Present? Method of Restraint Pressure ............... ......... Hydraulic ............... ......... Pressurized.............. ......... Vacuum ............... ......... Thermal ............... ......... Springs ............... ......... Gravity ............... ......... Electrical ............... ......... Capacitors............... ......... Battery ............... ......... Other ............... ......... Step 7. Ensure that the equipment is disconnected from the energy source(s) by first checking that no personnel are exposed, then verify the isolation of the equipment by operating the push button or other normal operating control(s). Test as described below to make certain the equipment will not operate. CAUTION: Return operating controls(s) to neutral or OFF position after verifying the isolation of the equipment. Procedures/test equipment used to verify isolation: Step 8. Lockout is complete. Perform service/maintenance as required. Restoring Equipment to Service When servicing/maintenance is completed, and the machine or equipment is ready to return to normal operating condition, the following steps must be taken: (Note: Add additional details/steps as needed to ensure safe start-up) Check the machine or equipment and the immediate area around the machine or equipment to ensure that nonessential items have been removed and that all necessary components are correctly re-assembled and intact. Check the work area to ensure that all affected employees have been notified of intention to start-up and are safety positioned or removed from the area. Verify that the controls are in the Aoff@ position. Remove the lockout devices and re-energize the machine/equipment. Notify affected employees that servicing is complete and machine/equipment is ready for use by using the same means used to inform them of impending shut-down. Special Considerations/Comments: This procedure was reviewed and approved for use by: Name/Title/Dept. Date Form Revision Date: 1/3/07 Page PAGE 1 of NUMPAGES 3 #&0efp|~„—Ÿ «³“ø¹ĖŃčļ # + , " . Ā ųšįšŲĶĀŗ®Ā„ŗš™‘ŗ‘ˆ|š‘šŲšŲšŲšqšeVeh~Ł5CJOJQJ\aJh~ŁCJOJQJaJh~Ł5CJ\aJh h~Ł>*CJaJh >*CJaJh CJaJhüZ>h~Ł>*CJaJhmZ>*CJaJhüZ>hüZ>5CJaJhüZ>CJaJhüZ>hüZ>CJaJh~Ł5CJ\aJh~Ł>*CJaJh~Ł56>*CJ\]aJh~ŁCJaJh~ŁCJaJ!%&0g„Ÿ “µŅÓļš ! " # ! 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