Mechanical Fabrication Department

Mechanical Fabrication Department

Equipment Lockout Procedure

For Enter Equipment Name

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Equipment Lockout Procedure

Section A. General Information

General Equipment Description:
PC # (s): / Equipment Custodian:
Manufacturer:
Model #: / Serial #:
Equipment Location:

Section B. Operator Controls

The following is a list of operator controls used to shut down the “enter name”:
· Control 1
· Control 2
· Control 2 (add or delete steps as necessary)
To place the equipment in a non-operational mode prior to any LOTO activities, the operator must perform the following actions:
· Step 1
· Step 2
· Step 3
· Step 4 (add or delete steps as necessary).

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Equipment Lockout Procedure

Section C: Identification of Energy Sources, Danger Zones, and Isolation

Potential types of energy / Describe if present / Danger zone / Isolation Point
A / Electrical - low voltage (50-600 V)
B / Electrical - low voltage (<50 V)
C / Electrical - high voltage (600 V)
D / Chemical -
E / Pressure- hydraulic, pneumatic
F / Vacuum
G / Mechanical - capable of crushing, pinching, cutting, snagging, striking
H / Thermal, heat
I / Thermal, cryogenic
J / Radiation, ionizing, non-ionizing
K / Stored energy - flywheel, springs, differences in elevation, capacitors, batteries.
L / Emergency power
M / Other- describe

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Equipment Lockout Procedure

Section D. Purpose of Procedure

This procedure describes the steps for safely de-energizing and locking out the “Enter name here” in preparation for maintenance, repair, or equipment modification work.

Section E. Shutdown steps

Preparation and Notification

A list of personnel “approved” to use this ELP is provided in Section G. Personnel who are authorized to apply general LOTO, but not listed as “approved” to use this ELP can:
· Request approval to use this ELP (see Section G); or
· Lock out the equipment in cooperation with a person approved to use this ELP (see Section G).
Review this entire LOTO procedure
Prior to starting work, notify all affected personnel of the lock out activity. Additionally, contact “enter name” to confirm that the equipment has been placed in the non-operational mode as described in Section B.
Insert any special contact information.
Isolation and Control of Energy Sources
The steps below describe how to isolate and control the energy sources identified in Section C. For each step, do the following:
· Determine if your job requires that you work in the “danger zone” for that energy source (see Section C).
· If you determine your job requires you to work in the danger zone for that energy source, perform the isolation and control step
· If you determine that your work does not require you to work in the danger zone for that energy source, you do not need perform the isolation and control step.

Energy Source A (electrical 50-600Volts) (delete this row if this energy source not present)

Description:
Isolate:
LOTO:
Dissipate:
Verify: If you will be performing only mechanical work, isolation of electrical energy shall be verified by ensuring the machine cannot be started. The check this, enter description of how to check.
If you will be performing electrical work, then verification requires voltage testing which is considered energized electrical work and requires an Electrical Work Plan (EWP). You must have an approved EWP to perform this step
Note: Arc hazard ratings and PPE requirements are required to be posted on electrical disconnects and circuit breaker panels. If this label is missing, do not operate the switch until the arc hazard can be determined.