Ontario Operations Zero Energy State Locking and Tagging Program

Lock Box Form - 50

Date: / Plant-specific Procedure Number(if applicable):
Project Description:
Q1-Is your task part of the listed project?
Q2-Are the listed Energy Isolation Devices adequate for the work you are doing?
Q3-Is the listed ZERO Energy verification adequate for the work you are doing?
/
Designated Tag Application
/
Remote Tag Application

Energy Isolating Devices:

Type of Device / Device Identification / Equipment Name / Location of Energy Isolating Device
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

Designated Taggers will fill in this form as described in Flowchart #1 of the Ontario Operations Zero Energy State Locking and Tagging Procedure MPROC-60001.

Subsequent Designated Taggers will add their name and date each time they become the Designated Tagger.

Revised June 2015Page 1 of 5

Ontario Operations Zero Energy State Locking and Tagging Program

Lock Box Form - 50

Date: / Plant-specific Procedure Number(if applicable):
Project Description:

Energy Isolating Devices:

Type of Device / Device Identification / Equipment Name / Location of Energy Isolating Device
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

Method to Use to Verify Zero Energy State:

Project Lock Installation:

Designated Tagger
Name: / Isolation Completed
/ Zero Energy Verified
/ Project Lock Installed
Date and Time:

Designated Taggers will fill in this form as described in Flowchart #1 of the Ontario Operations Zero Energy State Locking and Tagging Procedure MPROC-60001.

Subsequent Designated Taggers will add their name and date each time they become the Designated Tagger.

Revised June 2015Page 1 of 5

Ontario Operations Zero Energy State Locking and Tagging Program

Lock Box Form - 50

Date: / Plant-specific Procedure Number(if applicable):
Project Description:

Subsequent Designated Taggers:

Print the name and date of the designated Tagger who has control of the key for the project lock.
Name: / Date: / Name: / Date:

Designated Taggers will fill in this form as described in Flowchart #1 of the Ontario Operations Zero Energy State Locking and Tagging Procedure MPROC-60001.

Subsequent Designated Taggers will add their name and date each time they become the Designated Tagger.

Revised June 2015Page 1 of 5

Ontario Operations Zero Energy State Locking and Tagging Program

Lock Box Form - 50

Date: / Plant-specific Procedure Number(if applicable):
Project Description:

Designated Taggers will fill in this form as described in Flowchart #1 of the Ontario Operations Zero Energy State Locking and Tagging Procedure MPROC-60001.

Subsequent Designated Taggers will add their name and date each time they become the Designated Tagger.

Revised June 2015Page 1 of 5