The Control of Hazardo u s Energy (Lockout/Tago u t)

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October 20, 2013 Health and Safety Department, Herbion Pharmaceuticals, Korangi ndustrial !rea, Korangi Karachi, Pa"istan# Dear Sir$%adam& Helping you to impro'e your practices is of our highest priority# (hat is )hy )e are pleased to submit the brief document outlining and to create a SAFER WORKPLACE# %utually )e can design system that is used to secure or isolate energy sources on process e*uipment during maintenance acti'ities# +e understand that you ha'e been incorporating safe industriali,ed standards in your practices at your manufacturing facility# !lthough you ha'e e'ery reason to belie'e your )or"force are pleased )ith employer satisfaction you pro'ide, you )ould further li"e to gi'e them safer )or"place and en'ironment# -et.s say site ha'e a bro"en machine to fi/ in your plant# 0our )or"er turns off the po)er to it and fi/es it# 1ight2 3ut )hat happens if your )or"ers ha'e got their fingers in there and somebody turns it bac" on# (hat is )hy it is smart to 4tag out5 critical electrical s)itches )ith a sign that says to lea'e the s)itch O66# (o be e'en safer, you can put a loc" on the s)itch# (hat.s called a 4loc" out#5 !nd that is )hy you are reading this no)# OSH! standards at your manufacturing site )ants you to be a)are of the re*uirements for loc"ing7out or tagging7out 8controlling9 energy sources during ser'icing and$or maintaining of machines and e*uipment# +hat re*uirements2 +hy the re*uirements that are spelled out in the Occupational Safety and Health Standard 1:10#1;<, entitled 4(he =ontrol of Ha,ardous >nergy 8loc"out$tagout95# +e )ill loo" at the Standard and see ho) it is designed to help "eep you safe from the potential ha,ards posed by machines and e*uipment# +e )ill discuss the 'arious types of energy sources and ho) to "eep them from harming you# !nd, )e )ill loo" at a typical energy7control program, including loc"out 's# tagout along )ith loc"out$tagout e*uipment# +e )ill discuss the re*uirements for training and retraining to "eep you sharp and safe# +e )ill see ho) to apply the program both to loc"out$tagout procedures and finally, to procedures for restoring po)er# (han" you for your consideration and time# +e can be contacted *uic"ly on our office address#

The Control of Hazardo u s Energy (Lockout/Tago u t)

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TABLE OF CONTENTS
# # # @# Ob?ecti'e !ssignment of 1esponsibility -e'el71$ basic -O(O implementation strategy Procedures !# Preparation for -oc"out or (agout 3# >lectrical =# Hydraulic$Pneumatic D# 6luids and Aases ># %echanical >nergy 6# 1elease from -oc"out$(agout A# Ser'ice or %aintenance n'ol'ing %ore than One Person H# 1emo'al of an !uthori,ed >mployee.s -oc"out$(agout by the =ompany # Shift or Personnel =hanges B# Procedures for Outside Personnel$=ontractors K# (raining and =ommunication -# Periodic nspection @# !ttachments !# -ist of !uthori,ed Personnel for -oc"out$(agout Procedures 6orm 3# =ertification of (raining of !uthori,ed Personnel 6orm =# =ertification of (raining of !ffected Personnel 6orm D# -oc"out$(agout nspection =ertification 6orm ># Outside Personnel$=ontractor =ertification 6orm 6# >*uipment Specific Procedure 6orm @# Samples

ii

The Control of Hazardo u s Energy (Lockout/Tago u t)

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PROJECT CHARTER
1. Project Name (he control of ha,ardous energy 8loc"out$(ag out9 2. Project Business need Sa'ing accidental treatment =ost 3. Project oa!" Bene#its and o$jecti%es Safer )or" place 1educed !ccidents mpro'e communication 1educe Do)ntime &. Project de'endenc( mplementation of OSH! standards ). Project Constraints =areless )or"force >*uipments !'ailability >mployee %orale *# Project Assum'tions (rainings are sufficient to implement the pro?ect >*uipments )ill be a'ailable )hen needed +or"force )ill follo) instructions

+# Project Ris,s ncrease in do)ntime =ommunication gap ncrease in employee dependency

-. Project Parameters Sco'e. (o establish a means of positi'e control to pre'ent the accidental starting of machines Sc/edu!e& Pro?ect )ill complete )ithin 3 months of starting date# Cost. (he ma0imum cost t/at can $e assi1ned to t/is 'roject 2i!! $e Rs 3.3 mi!!ion

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4. Project 5e!i%era$!es Personnel Safety ncrease >mployee %orale ncrease Bob Satisfaction 6or, Brea, do2n Implement Lock out/Tag out Meetin g Arrange worksho p Budget Allocat ion Order equipments Traini ng Documentat ion 73. 77. 72. System Implementation

Project Or1ani8ation Cuality %anager )ill act on behalf on his organi,ation# n his absence !sst# %anager )ill ta"e the 1esponsibility# %r# +aha? 3in Bamal )ill act as pro?ect %anager# n his absence %r# Salman Shei"h can be contacted# 9e( Sta,e/o!ders >mployees Cuality Department Director =ontractor uidin1 'rinci'!es >mployee training program )ill be arranged by pro?ect team# %easures )ill be ta"en for uninterrupted production during pro?ect# 3udget can sub?ect to changes )ith change in go'ernment policies# (he pro?ect team )ill )arranty the e*uipments for 1 year#

The Control of Hazardo u s Energy (Lockout/Tago u t)

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STA9EHOL5ER ANAL:S;S
CO<<=N;CAT;ON STRATE : >7mail,=all

S.No

NA<E

S6OT

;NTEREST

;NFL=ENCE

Pro?ect 6irm

Opportunity

3usiness

High

Cuality Department

Strength

=ertification

High

>7mail,=all

%aintenance Department

Opportunity

Safety

%oderate

>7mail,=all

Director

Strength

3usiness

-o)

>7mail

=ontractor

Opportunity

3usiness

%oderate

=all

The Control of Hazardo u s Energy (Lockout/Tago u t)

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RESPONS;B;L;T: ASS; N<ENT <ATR;> ?RA<@

S.No .
1

6/at is to $e 5one ?Acti%ities@

%eeting

Team mem$er Name

Project Firm
1 =

Aau!it( 5e'artment
= 1

<aintenance 5e'artment
= S S

5irecto r

Contractor

2 3udget !llocation 3 %eeting ; Order >*uipments D (raining E < Documentation System mplementation

= = ! @

1 1 ! S S = = @ 1

= 1 1 !

T('ica! Ro!e 5e#initions. RF ; F nform 1esponsible A7 !ccountable B7 'erify

C F =onsult

S F Support

The Control of Hazardo u s Energy (Lockout/Tago u t)

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LOC9O=TCTA O=T PROCE5=RE

;. OBJECT;BE

(he ob?ecti'e of this procedure is to establish a means of positi'e control to pre'ent the accidental starting or acti'ating of machinery or systems )hile they are being repaired, cleaned and$or ser'iced# (his program ser'es to& !# >stablish a safe and positi'e means of shutting do)n machinery, e*uipment and systems# 3# Prohibit unauthori,ed personnel or remote control systems from starting machinery or e*uipment )hile it is being ser'iced# =# Pro'ide a secondary control system 8tagout9 )hen it is impossible to positi'ely loc"out the machinery or e*uipment# D# >stablish responsibility for implementing and controlling loc"out$tagout procedures# ># >nsure that only appro'ed loc"s, standardi,ed tags and fastening de'ices pro'ided by the company )ill be utili,ed in the loc"out$tagout procedures# ;;. ASS; N<ENT OF RESPONS;B;L;T: !# Responsible Person )ill be responsible for implementing the loc"out$tagout program# 3# Responsible Persons are responsible for enforcing the program and insuring compliance )ith the procedures in their departments# =# Responsible Person is responsible for monitoring the compliance of this procedure and )ill conduct the annual inspection and certification of the authori,ed employees# D# Authorized employees 8those listed in !ttachment !9 are responsible for follo)ing established loc"out$tagout procedures# !n authori,ed employee is defined as a person )ho loc"s out or tags out machines or e*uipment in order to perform ser'icing or maintenance on that machine or e*uipment# !n affected employee becomes an authori,ed employee )hen that employeeGs duties include performing ser'icing or maintenance co'ered under 1:10#1;<, (he =ontrol of Ha,ardous >nergy 8loc"out$tagout9# ># Affe ted employees 8all other employees in the facility9 are responsible for insuring they do not attempt to restart or re7energi,e machines or e*uipment that are loc"ed out or tagged out# !n affected employee is defined as a person )hose ?ob re*uires him$her to operate or use a machine or e*uipment on )hich ser'icing or maintenance is being performed under loc"out or tagout, or )hose ?ob re*uires him$her to )or" in an area in )hich such ser'icing or maintenance is being performed#

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SCHE5=LE <ANA E<ENT PLAN

7. enera! Project ;n#ormation Pro?ect Hame& (he control of ha,ardous energy -ocation& Herbion Pharma Pro?ect %anager& +aha? 3in Bamal O$jecti%es Schedule acti'ities Synchroni,e planning Set priorities !ssign ?ob to each indi'idual Sc/edu!e Assum'tions Safety personnel needs to rotate in shifts !ll personnel protecti'e e*uipment )ill not be a'ailable during training session Sc/edu!e Constraints (raining date )as set prior to procurement of all PP>.s -ac" of trained resource a'ailability Sc/edu!e ris,s Difficult to shutdo)n machines during production run Sc/edu!e c/an1e contro! %eeting is planned on )ee"ly basis and all members are responsible to participate in it# !ny change )ill be done )ith a final appro'al of pro?ect manager =hange re*uest form has been used for any change Sc/edu!in1 Process Scheduling process is continued to update as pro?ect progresses after a)areness session in the start# Schedule is updated after e'ery )ee"ly meeting >ntire pro?ect to be completed in three months Sc/edu!e t('es Schedule type used is Aant =hart Sc/edu!in1 Res'onsi$i!ities Scheduling responsibilities is handled by %r# !bid 1asheed# O'erall acti'ities are to be re'ie)ed by pro?ect manager 6

2.

3.

&.

). *.

!.

".

#.

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LEBELD7C BAS;C LOTO ;<PLE<ENTAT;ON STRATE :

A2areness and im'ortance o# Loc, outC Ta1 out to or1ani8ation 'ersonne! EPRESENTAT;ONF o $ASK%1& +hat is -O$(O2 !nd )hy it is necessary2

;denti#ication #or LOCTO EPREL;<;NAR: PREPERAT;ONSF. o $ASK%1& dentification of utilities area$ machinery and preparation of list of e*uipments# dentification of !uthori,ed and !ffected Personal for PD(#

o $ASK%'& Decision of 6abricating -oc"s$ mport -oc"s#

E0ecution o# LOCTO im'!ementation . o $ASK%1& Ordering -oc"s$ 6abrication of -oc"s, -oc"out Station#

o $ASK%'& Deli'ery for -O$(O >*uipments#

LOCTO im'!ementation and Trainin1EPROCESS ;<PROBENTF. o $ASK%1& Documentation for (raining, SOP, PD( 8(!AS9#

o $ASK%'& (raining# 7

The Control of Hazardo u s Energy (Lockout/Tago u t)

o $ASK%(& Demonstration of Procedure#

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<i!estoneD)EPROJECT CLOS;N o $ASK%1&

G Pre'aration #or Le%e!D2F.

Iser =hec"$ satisfaction#

o $ASK%'& Handling of -O(O >*uipment, documents and PD(#

The Control of Hazardo u s Energy (Lockout/Tago u t)

;B. PROCE5=RES (he ensuing items are to be follo)ed to ensure both compliance )ith the OSH! =ontrol of Ha,ardous >nergy Standard and the safety of your employees# A. Pre'aration #or Loc,out or Ta1out

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>mployees )ho are re*uired to utili,e the loc"out$tagout procedure 8see !ttachment !9 must be "no)ledgeable of the different energy sources and the proper se*uence of shutting off or disconnecting energy means# (he four types of energy sources are& 1# 2# 3# ;# electrical 8most common form9J hydraulic or pneumaticJ fluids and gasesJ and mechanical 8including gra'ity9#

%ore than one energy source may be utili,ed on some e*uipment and the proper procedure must be follo)ed in order to identify energy sources and loc"out$tagout accordingly# See !ttachment 6 for specific procedure format# B. E!ectrica! 1# 2# 3# ;# D# Shut off po)er at machine and disconnect# Disconnecting means must be loc"ed or tagged# Press start button to see that correct systems are loc"ed out# !ll controls must be returned to their safest position# Points to remember& a# f a machine or piece of e*uipment contains capacitors, they must be drained of stored energy# b# Possible disconnecting means include the po)er cord, po)er panels 8loo" for primary and secondary 'oltage9, brea"ers, the operatorGs station, motor circuit, relays, limit s)itches, and electrical interloc"s# c# Some e*uipment may ha'e a motor isolating shut7off and a control isolating shut7off# d# f the electrical energy is disconnected by simply unplugging the po)er cord, the cord must be "ept under the control of the authori,ed employee or the plug end of the cord must be loc"ed out or tagged out#

C. H(drau!icCPneumatic 1# 2# 3# Shut off all energy sources 8pumps and compressors9# f the pumps and compressors supply energy to more than one piece of e*uipment, loc"out or tagout the 'al'e supplying energy to the piece of e*uipment being ser'iced# Stored pressure from hydraulic$pneumatic lines shall be drained$bled )hen release of stored energy could cause in?ury to employees# %a"e sure controls are returned to their safest position 8off, stop, standby, inch, ?og, etc#9# ases 9

5. F!uids and

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1# 2# 3# ;# E#

dentify the type of fluid or gas and the necessary personal protecti'e e*uipment# =lose 'al'es to pre'ent flo), and loc"out$tagout# Determine the isolating de'ice, then close and loc"out$tagout# Drain and bleed lines to ,ero energy state# D# Some systems may ha'e electrically controlled 'al'es# f so, they must be shut off and loc"ed$tagged out# =hec" for ,ero energy state at the e*uipment#

E. <ec/anica! Ener1( %echanical energy includes gra'ity acti'ation, energy stored in springs, etc# 1# 2# 3# ;# D# 3loc" out or use die ram safety chain# -oc"out or tagout safety de'ice# Shut off, loc"out or tagout electrical system# =hec" for ,ero energy state# 1eturn controls to safest position#

F. Re!ease #rom Loc,outCTa1out 1# 2# 3# ;# D# E# nspection& %a"e certain the )or" is completed and in'entory the tools and e*uipment that )ere used# =lean7up& 1emo'e all to)els, rags, )or"7aids, etc# 1eplace guards& 1eplace all guards possible# Sometimes a particular guard may ha'e to be left off until the start se*uence is o'er due to possible ad?ustments# Ho)e'er, all other guards should be put bac" into place# =hec" controls& !ll controls should be in their safest position# (he )or" area shall be chec"ed to ensure that all employees ha'e been safely positioned or remo'ed and notified that the loc"out$tagout de'ices are being remo'ed# 1emo'e loc"s$tags# 1emo'e only your loc" or tag#

. Ser%ice or <aintenance ;n%o!%in1 <ore t/an One Person +hen ser'icing and$or maintenance is performed by more than one person, each authori,ed employee shall place his o)n loc" or tag on the energy isolating source# (his shall be done by utili,ing a multiple loc" scissors clamp if the e*uipment is capable of being loc"ed out# f the e*uipment cannot be loc"ed out, then each authori,ed employee must place his tag on the e*uipment#

H. Remo%a! o# an Aut/ori8ed Em'!o(eeHs Loc,outCTa1out $( t/e Com'an(

10

The Control of Hazardo u s Energy (Lockout/Tago u t)

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>ach location must de'elop )ritten emergency procedures that comply )ith 1:10#1;<8e9839 to be utili,ed at that location# >mergency procedures for remo'ing loc"out$tagout should include the follo)ing& 1# 2# 3# @erification by employer that the authori,ed employee )ho applied the de'ice is not in the facility# %a"e reasonable efforts to ad'ise the employee that his$her de'ice has been remo'ed# 8(his can be done )hen he$she returns to the facility9# >nsure that the authori,ed employee has this "no)ledge before he$she resumes )or" at the facility#

;. S/i#t or Personne! C/an1es >ach facility must de'elop )ritten procedures based on specific needs and capabilities# >ach procedure must specify ho) the continuity of loc"out or tagout protection )ill be ensured at all times# J. Procedures #or Outside Personne!CContractors Outside personnel$contractors shall be ad'ised that the company has and enforces the use of loc"out$tagout procedures# (hey )ill be informed of the use of loc"s and tags and notified about the prohibition of attempts to restart or re7energi,e machines or e*uipment that are loc"ed out or tagged out# (he company )ill obtain information from the outside personnel$contractor about their loc"out$tagout procedures and ad'ise affected employees of this information# (he outside personnel$contractor )ill be re*uired to sign a certification form 8see !ttachment >9# f outside personnel$contractor has pre'iously signed a certification that is on file, additional signed certification is not necessary# 9. Trainin1 and Communication >ach authori,ed employee )ho )ill be utili,ing the loc"out$tagout procedure )ill be trained in the recognition of applicable ha,ardous energy sources, type and magnitude of energy a'ailable in the )or" place, and the methods and means necessary for energy isolation and control# >ach affected employee 8all employees other than authori,ed employees utili,ing the loc"out$tagout procedure9 shall be instructed in the purpose and use of the loc"out$tagout procedure, and the prohibition of attempts to restart or re7energi,e machines or e*uipment that are loc"ed out or tagged out# (raining )ill be certified using !ttachment 3 8!uthori,ed Personnel9 or !ttachment = 8!ffected Personnel9# (he certifications )ill be retained in the employee personnel files# L. Periodic ;ns'ection

11

The Control of Hazardo u s Energy (Lockout/Tago u t)

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! periodic inspection 8at least annually9 )ill be conducted of each authori,ed employee under the loc"out$tagout procedure# (his inspection shall be performed by the )Responsible person* # f )Responsible person* is also using the energy control procedure being inspected, then the inspection shall be performed by another party# (he inspection )ill include a re'ie) bet)een the inspector and each authori,ed employee of that employeeGs responsibilities under the energy control 8loc"out$tagout9 procedure# (he inspection )ill also consist of a physical inspection of the authori,ed employee )hile performing )or" under the procedures# (he )Responsible person* shall certify in )riting that the inspection has been performed# (he )ritten certification 8!ttachment D9 shall be retained in the indi'idualGs personnel file#

12

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COST <ANA E<ENT PLAN

7. Project ;n#ormation Pro?ect Hame& mplementation of -O(O procedure -ocation& Aet, Pharma Pro?ect %anager& +aha? 3in Bamal 2. Cost Assum'tions =ost )ill not 'ary as pro?ect proceeds# !ll standard tools$ser'ices are a'ailable# 3. Cost Constraints Organi,ations budget &. Cost Ris,s Ao'ernment policies (a/es >/change rates ). Bud1et Sources and A''ro%a!s Pro?ect is funded by Herbion pharma !ppro'ed by senior top management *. Cost <ana1ement Ro!es Pro?ect manager )ill intimate any change in budget after consultation )ith team members !ppro'al of higher authority re*uired if budget de'iates more than 1s#D0,000# +. Project Estimation Tec/niIues 3ottom up estimate has been used -. C/an1es to t/e Bud1et Pro?ect changes are appro'ed by sponsor but )ithin limit of 1s# D0000 nitially planned for 1s# 3 million but end up )ith 3#2D million# 4. Cost and E0'enditure trac,in1 (otal pro?ect cost is 1s# 3 million (raining session costs 1s# 100,000 >*uipment for each cost 1s# D0000, and )e ha'e total of E0 machines 73. Cost C!oseout nitially planned for 1s# 3 million but end up )ith 3#2D million

77. Lessons Learned 13

The Control of Hazardo u s Energy (Lockout/Tago u t)

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!fter pro?ect appro'al immediately place orders for e*uipments due to uncertain go'ernment policies# nclude e/change rate tolerance in your budget

A=AL;T: <ANA E<ENT PLAN

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The Control of Hazardo u s Energy (Lockout/Tago u t)

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7.

enera! Project ;n#ormation Pro?ect Hame& (he =ontrol of Ha,ardous >nergy -ocation& Herbion Pharma Pro?ect %anager& +aha? 3in Bamal

2. Aua!it( Assum'tions (his in'ol'es OSH! control system is follo)ed Standardi,ed e*uipment are used throughout 3. Aua!it( Constraints (he belo) constraint )ill limit the *uality team options People in'ol'ed in )or"ing are not a)are of different energy sources that has been used &. Aua!it( Ris,s -ist any ris"s identified during the de'elopment of the *uality management Plan# 6or e/ample& %ore than one energy sources are utili,ed on some e*uipment# 3ut people are not trained accordingly ). Settin1 Project Aua!it( Standards Cuality standards should be follo)ed to meet the utmost ob?ecti'e
Ensure quality complianc e

Checklist of daily activitie s

Periodic maintenan ce

Implement ation of OSHA standard

Training session

No. of worker got trained

Inspectio n

Audits

Provide PPEs

Use of standardi ze locks and tags

). Aua!it( Assurance Pro1ram !s per belo) listed, *uality assurance program has been set up

15

The Control of Hazardo u s Energy (Lockout/Tago u t)

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mplementation of lean si/ sigma at SA- )ill definitely help to re'ie) as it in'ol'es tagging on machines =ompliance )ith SO and OSH! should be follo)ed SOP are designed to perform logout and tag out of machines (hird party audit )ill ensure current safety position %ulti s"ill operator need to be trained )ith safety precaution %ista"e proofing strategy is employed Pareto analysis has been done on all machines to identify those that s)itches to out of order fre*uently

*. Aua!it( Contro! Pro1ram Outline the Cuality =ontrol. 8C=9 techni*ues that the pro?ect )ill implement# (his may include any of the follo)ing actions& >liminate error by rectifying human procedure C= manuals are updated )ith re'ised SOP %achines cannot be s)itch on unless it passes desired criteria +ee"ly status report to be re'ie)ed regularly =ause and effect diagram is used to rectify fre*uently occurred errors

+# Aua!it( Ro!es and Res'onsi$i!ities !ll *uality related issues )ill handle by %r# !bid# !ll team member )ill support to achie'e high *uality standards

ATTACH<ENT A
List o# Aut/ori8ed Personne! #or Loc,outCTa1out Procedures
16

The Control of Hazardo u s Energy (Lockout/Tago u t)

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H!%>

BO3 ( (->

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

17

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ATTACH<ENT B
Certi#ication o# Trainin1 ?Aut/ori8ed Personne!@ certify that recei'ed training as an authori,ed employer under Comp+ny ,+me further certify that understand the procedures and )ill

-oc"out$(agout program# abide by those procedures#

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK !I(HO1 L>D >%P-O0>> S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

18

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ATTACH<ENT C
Certi#ication o# Trainin1 ?A##ected Personne!@

certify that recei'ed training as an !ffected >mployee under Comp+ny ,+me -oc"out$(agout Program# further certify and understand that am prohibited from

attempting to restart or re7energi,e machines or e*uipment that are loc"ed out or tagged out#

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK !I(HO1 L>D >%P-O0>> S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

19

The Control of Hazardo u s Energy (Lockout/Tago u t)

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ATTACH<ENT 5
Loc,outCTa1out ;ns'ection Certi#ication

certify that

E-uipment

)as inspected on Mthis dateN utili,ing loc"out$tagout

procedures# (he inspection )as performed )hile )or"ing on E-uipment #

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK !I(HO1 L>D >%P-O0>> S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK HSP>=(O1 S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

20

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ATTACH<ENT E
Outside Personne!CContractor Certi#ication

certify that

and

8outside

personnel$contractor9 ha'e informed each other of our respecti'e loc"out$tagout procedures#

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK !I(HO1 L>D >%P-O0>> S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK HSP>=(O1 S AH!(I1>

KKKKKKKKKKKKKKKKKK D!(>

21

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ATTACH<ENT F
EIui'ment S'eci#ic Procedure #or Com'an( Name
?5ate@

<ac/ine ;denti#ication Aeneral Description& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK %anufacturer& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK %odel Humber& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK Serial Humber&O KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
* If more than one piece of same equipment, list all serial numbers.

-ocation of e*uipment& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK O'erator Contro!s (he types of controls a'ailable to the operator need to be determined# (his should help identify energy sources and loc"out capacity for the e*uipment# -ist types of operator controls& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

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The Control of Hazardo u s Energy (Lockout/Tago u t)

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Ener1( Sources (he energy sources, such as electrical, steam, hydraulic, pneumatic, natural gas, stored energy, etc#9 present on this e*uipment are&
Loc,a$!e :es No T('e !oc, or $!oc, needed

ENER : SO=RCE

LOCAT;ON

S/utdo2n Procedures -ist the steps in order necessary to shut do)n and de7energi,e the e*uipment# 3e specific# 6or stored energy, be specific about ho) the energy )ill be dissipated or restrained# Procedure& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK -oc" (ype P -ocation& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK Ho) +ill De7energi,ed State 3e @erified2 KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
,O$.F/ ALL AFFEC$E0 E1PLO/EES W2E, $2.S PROCE03RE .S ., APPL.CA$.O, #

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The Control of Hazardo u s Energy (Lockout/Tago u t)

Start =' Procedures -ist the steps in order necessary to reacti'ate 8energi,e9 the e*uipment# 3e specific#

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Procedure& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK >nergy Source !cti'ated& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
,O$.F/ ALL AFFEC$E0 E1PLO/EES W2E, $2.S PROCE03RE .S ., APPL.CA$.O, #

Procedures For O'erations and Ser%iceC<aintenance -ist those operations )here the procedures abo'e do not apply MSee 2: =61 1:10#1;< 8a9829N# !lternate measures )hich pro'ide effecti'e protection must be de'eloped for these operations# Bob Safety !nalysis is one method of determining appropriate measures# Operation Hame& KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

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The Control of Hazardo u s Energy (Lockout/Tago u t)

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A##ected and Aut/ori8ed Em'!o(ees -ist each person affected by this procedure and those authori,ed to use this procedure# AFFECTE5 E<PLO:EES Name Jo$ Tit!e

A=THOR;JE5 E<PLO:EES Name Jo$ Tit!e

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK !ppro'ed by Date

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