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:

1. Notification: Notify all affected employees that a lockout/tagout procedure is going to be implemented and the reason for it.

2. Identification: Clearly identify the equipment or machinery to be locked out.

3. Shutdown: Turn off the equipment following the standard shutdown procedure.

4. Isolation: Isolate the equipment from its energy source(s).
   

5. Lockout/Tagout Application: Apply lockout/tagout devices to each energy isolation point.

6. Stored Energy: Ensure that any stored energy (electrical, mechanical, hydraulic, etc.) is released or restrained.

7. Verification: Verify that the equipment is isolated from its energy source by attempting to operate it.

Lockout/Tagout Devices Used:

1. Locks: [2 heavy-duty padlocks]

2. Tags: [2 warning tags ("Do Not Operate")]

3. 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]

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