Lockout/Tagout Procedure Template

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Perform all lockout/tagout procedure steps from top to bottom starting with page 1. Lock out & tag out the energy isolating device(s) with assigned individual lock(s) and tag(s)."

Lockout/Tagout Procedure Template

Potential Hazards:

  • Electrical
  • Pneumatic
  • Learn the potential hazards of lockout/tagout from our Lockout/Tagout Procedure TemplateWater
  • Valve
  • Gas
  • Steam
  • Magnetic Energy
  • Capacitance
  • Potential Energy
  • Hydraulic Energy
  • Thermal Energy
  • Kinetic Energy

Method of Isolation(s):

  • News-4Move disconnect to off
  • Trace cord and unplug
  • Move switch to off position
  • Move breaker to off position
  • Turn valve to closed position
  • Disconnect fitting
  • Disconnect all install flange
  • Disconnect and install cap.

Type of Device(s):

  • Padlock
  • Wall Switch Device
  • Universal Plug Device
  • Ball Valve Device
  • Gate Valve Device
  • Breaker Device
  • Cable Device
  • Quick Disconnect Device
  • Flange
  • Cap

Shutdown Sequence

  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.
  2. The authorized employee shall refer to the company procedure to identify the type and magnitude of the energy that the machine or equipment utilizes, shall understand the hazards of the energy, and shall know the methods to control the energy.
  3. 1If the machine or equipment is operating, shut it down by the normal stopping procedure (depress the stop button, open switch, close valve, etc.). Reference operating procedure for normal shutdown.
  4. Follow graphical lockout/tagout procedure from top to bottom to de-activate the energy isolating device(s) so that the machine or equipment is isolated from the energy source(s).
  5. Perform all lockout/tagout procedure steps from top to bottom starting with page 1. Lock out & tag out the energy isolating device(s) with assigned individual lock(s) and tag(s).
  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.
  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) or by testing to make certain the equipment will not operate. Note: Verify all interlocks, on/off buttons, etc. are in proper position for startup to ensure that the lockout is the only means of deenergization when attempting restart.

Caution: Return operating control(s) to neutral or “off” position after verifying the isolation of the equipment.

Restore to Service Sequence

  1. Check the machine or equipment and the immediate area around the machine to ensure that nonessential items such as parts and tools have been removed and that the machine or equipment components are operationally intact including replacement of guards, interlocks, etc.
  2. Check the work area to ensure that all employees have been safely positioned or removed from the area.
  3. Verify that the controls are in neutral.
  4. Remove the locks, tags and lockout devices and reenergize the machine or equipment. Reverse the order of all lockout/tagout procedure steps from bottom to top starting from the last page. Note: The removal of some forms of blocking may require reenergization of the machine before safe removal.
  5. Notify affected employees that the servicing or maintenance is completed and the machine or equipment is ready for use.

Contact ESC Services for help implementing your lockout strategy.

About Kristopher Carreon
Kristopher Carreon has managed multiple lockout/tagout implementation projects for many large companies in the US and Internationally. He has worked in various industries including manufacturing, automotive, lumber, mining, and railroad. Kris specializes in mining facilities and has a clear understanding of what is needed for the clients to meet their MSHA regulations.