Workplace Lockout/Tagout Procedure Form
Workplace Lockout/Tagout Procedure Form
|
Date |
[28/11/2050] |
|
Time |
[09:00 AM] |
|
Equipment Name/ID |
[Hydraulic Press HP-2001] |
|
Department |
[Production] |
|
Performed By |
[Your Name] |
|
Supervisor |
[Name] |
Procedure Steps:
-
Notification: Notify all affected employees that a lockout/tagout procedure is going to be implemented and the reason for it.
-
Identification: Clearly identify the equipment or machinery to be locked out.
-
Shutdown: Turn off the equipment following the standard shutdown procedure.
-
Isolation: Isolate the equipment from its energy source(s).
-
Lockout/Tagout Application: Apply lockout/tagout devices to each energy isolation point.
-
Stored Energy: Ensure that any stored energy (electrical, mechanical, hydraulic, etc.) is released or restrained.
-
Verification: Verify that the equipment is isolated from its energy source by attempting to operate it.
Lockout/Tagout Devices Used:
-
Locks: [2 heavy-duty padlocks]
-
Tags: [2 warning tags ("Do Not Operate")]
-
Chain: [1 metal chain (4 feet)]
Additional Notes:
The hydraulic press has been reported to have irregular pressure fluctuations.
Extra caution is advised while handling the press post-maintenance.
Performed By:
[Your Name]
[12/01/2050]
Supervisor:
[Your Name]
[12/01/2050]
