Management Plan for Lockout Tagout (LOTO) ISD #535

Similar documents
OKLAHOMA CITY COMMUNITY COLLEGE CONTROL OF HAZARDOUS ENERGY PROGRAM. Environmental Health and Safety. Established:

THE UNIVERSITY OF NORTH CAROLINA

ARKANSAS TECH UNIVERSITY FACILITIES MANAGEMENT HEALTH AND SAFETY MANUAL (LOCKOUT/TAGOUT) 30.0

PART Q CONTROL OF HAZARDOUS ENERGY (LOCKOUT-TAGOUT)

Lockout/Tagout Safety Policy

SAFETY DIRECTIVE 2.0 DEPARTMENTS AFFECTED. This Administrative Directive shall apply to all Town of Marana departments and employees.

230-LOCKOUT/TAGOUT PROGRAM

Gettysburg College. Energy Control Program

DUQUESNE UNIVERSITY LOCKOUT/TAGOUT PROGRAM

Product Information Report Lockout/Tagout Hazardous Energy Control

LO/TO LOCKOUT/TAGOUT PROGRAM

Lock Out/Tag Out Control of Hazardous Energy

Lockout/Energy Control

Control of Hazardous Energy. Environmental Health and Safety

CONTROL OF HAZARDOUS ENERGY (LOCKOUT/TAGOUT) PROGRAM

Lockout / Tagout Program OSHA 29 CFR

Health, Safety, Security and Environment

PAGE 1 OF 7 HEALTH, SAFETY & ENVIROMENTAL MANUAL PROCEDURE: S230 Lock-Out Tag-Out (LOTO) Program REV 4.0 8/13/2012

CONTROL OF HAZARDOUS ENERGY (LOCKOUT/TAGOUT)

UCHC Lockout/Tagout Policy (4/09)

Lockout / Tag out Program

Lock Out - Tag Out Safety Program

Facilities Management

CITY OF NEW LONDON LOCKOUT/TAGOUT PROGRAM

CONTROL OF HAZARDOUS ENERGY

Control of Hazardous Energy Program (LOTO)

Lockout/Tagout Program Occupation Safety & Health Standards for General Industry 29 CFR

PRESCOTT SCHOOL DISTRICT NO South A Street Prescott, WA The Control of Hazardous Energy (Lockout/Tagout)

Hazardous Energy Control (Lockout-Tagout)

University of Arkansas Office of Environmental Health and Safety

LOCKOUT-TAGOUT PROGRAM

University of Illinois at Chicago. Control of Hazardous Energy Program (Lockout/Tagout)

Lockout / Tagout Safety Program

Lockout/Tagout Manual

SUNY OSWEGO ENVIRONMENTAL HEALTH AND SAFETY

ILLINOIS INSTITUTE OF TECHNOLOGY SAFETY COMMITTEE

Lockout/Tagout - Control of Hazardous Energy Program

LOCKOUT / TAGOUT PROGRAM

Lockout Tagout Program

CONTROL OF HAZARDOUS ENERGY (LOCKOUT/TAG OUT PROGRAM) Washington State University Tri-Cities (all departments)

LOCKOUT/TAGOUT PROGRAM

Lockout/Tagout. Page. Introduction. Purpose. 2 Background. 2 Who s Covered?... 3 Responsibilities. 3 Explanation of Key Terms. 4.

LOCK-OUT/TAG-OUT (LO/TO) SAFETY PROGRAM

WESTERN CONNECTICUT STATE UNIVERSITY LOCKOUT/TAGOUT PROCEDURE S-107

Lockout/Tagout Training Overview. Safety Fest 2013

Lockout Tagout Program

LOCKOUT/TAGOUT PLAN August 2015

Control of Hazardous Energy Lockout / Tagout Program

H. Control of Hazardous Energy: Lockout/Tag Out

SUNY OSWEGO ENVIRONMENTAL HEALTH AND SAFETY

DRAFT LOCKOUT/TAG OUT PROGRAM (CONTROL OF HAZARDOUS ENERGY)

EM385 Construction Safety and Health Certification Course Section 12 Control of Hazardous Energy

University of Vermont Department of Physical Plant Burlington, Vermont

MARIPOSA COUNTY LOCKOUT/TAGOUT PROGRAM

Lockout/Tagout - Energy Control Program

LOCKOUT/TAGOUT PROGRAM

Lockout/Tagout Plan Environmental Health & Safety Office July 2017

Page: 7/15/2009. Energy control procedures Use of lockout/tagout equipment to ensure safe work practices.

Energy Control Procedures Lockout/Tagout 29 CFR

Health & Safety Policy and Procedures Manual SECTION 6 ELECTRICAL SAFETY / CONTROL OF HAZARDOUS ENERGY

CONTROL OF HAZARDOUS ENERGY LOCKOUT/TAGOUT PROGRAM

Environmental Health & Safety

PROGRAM: Control of Hazardous Energy (LOCKOUT) Chapter 5

Lockout Tagout Policy

LOCKOUT AND TAGOUT. PART 1: INTRODUCTION

E2.14 Control of Hazardous Energy. Effective Date: 03/01/2018

DuPage County Environmental, Safety, Health & Property Loss Control Program Hazardous Energy Control (Lockout/Tagout)

LOCK OUT \ TAG OUT PROGRAM

CONTROL OF HAZARDOUS ENERGY IN THE WORKPLACE

Lockout/Tagout Program

LOCKOUT TAGOUT. Quick Reference FAQs REQUIREMENTS OF THE STANDARD COMMONLY USED TERMS

MCW s Control of Hazardous Energy Program

2523-LDG-E. Leader s Guide

LOCKOUT/TAGOUT PROGRAM

Hazardous Energy Control

RiskTopics. Lockout/Tagout October 2017

Health and Fire Safety Review 2/15

Lockout Tagout Program

LOCKOUT/TAGOUT: Operating Procedure TABLE OF CONTENTS

SUNY OSWEGO ENVIRONMENTAL HEALTH AND SAFETY

Lockout/Tagout Program

Control of Hazardous Energy Program (Lockout/Tagout)

Lockout / Tagout Program. The Control of Hazardous Energy. Environmental Health and Safety Office

WEST VIRGINIA UNIVERSITY TABLE OF CONTENTS

University of Tennessee Safety Program

Energy Control. Suite 2A, 55 Frid Street Hamilton, ON L8P 4M3 office: cell:

The Control of Hazardous Energy Program TABLE OF CONTENTS

Issue: Issued By: Environment, Health & Safety Part: Hazard Identification and Assessment Revision #: 2 Revision

SAMPLE WRITTEN PROGRAM for Control of Hazardous Energy LOCKOUT TAGOUT

Elements of a Lockout/Tagout Program OSHA

Sample Written Program for The Control of Hazardous Energy (Lockout/Tagout)

Lockout/Tagout Program

Environmental Health and Safety (EH&S) Revision Date: Initial. Prepared by: EH&S and Facility Management and Campus Services (FMS)

ITHACA COLLEGE LOCKOUT/TAGOUT PROGRAM

Hazardous Energy Control Lockout/Tagout

The Control of Hazardous Energy (Lockout/Tagout) California State University Chico

Texas Department of Insurance Division of Workers Compensation. Lockout Tagout HS96-100D (8-06)

TAMPA ELECTRIC COMPANY ENERGY SUPPLY HAZARDOUS ENERGY CONTROL LOCKOUT PROGRAM

2. The purpose of this program is to achieve the following objectives:

LOCKOUT/TAGOUT POLICY

Transcription:

Management Plan for Lockout Tagout (LOTO) ISD #535 Health & Safety Office Maintenance Service Building 10 SE 9½ Street Rochester, MN 55904 507-328-4507

Modification Date Document Modification Form All document modifications must be recorded on this form. Modification Description Modifications By Purpose of Modification Approved By 12-10-2007 Annual Review Michael Stock Update M.S. 10-23-2008 Changed Office Phone Number Michael Stock Update M.S. 12-03-2009 Annual Review Michael Stock Update M.S. 12-17-2010 Annual Review Michael Stock Update M.S. 4-27-2012 Annual Review Michael Stock Update M.S. 6-11-2013 Annual Review Michael Stock Update M.S. 5-29-2014 Added New Logo Bambie House Update M.S. 2

Table of Contents 1.0 Purpose 1.1 Authority and Reference 1.2 Definitions 1.3 Responsibility for Compliance 1.4 Energy Control Procedures 1.5 Equipment for Lockout/Tagout 1.6 Sequence of Lockout 1.7 Procedures for Group Lockout/Tagout 1.8 Restoring Equipment to Service 1.9 Training 1.10 Contractor Relations 1.11 Annual Periodic Inspections 1.12 Removal of Absent Persons LOTO Device/Locks 3

1.0 Purpose The purpose of this Hazardous Energy Control Program (Lockout/Tagout) is to safeguard employees from the unexpected start-up of equipment during service and maintenance activities. This program also describes the training that is necessary to inform employees on the details of the program, how it is being implemented, and the significance of non-compliance. 1.1 Authority and Reference Occupational Safety and Health Administration (OSHA) 29 CFR 1910.147 1.2 Definitions Affected Employee An employee whose job requires him/her to operate or use a machine or equipment on which servicing or maintenance is being performed under lockout or tagout, or whose job requires him/her to work in an area in which servicing or maintenance is being performed. Authorized Employee A knowledgeable person who has the authority to lock out and tagout machines or equipment being repaired or serviced. Disconnecting Means A device that cuts off the source of power to equipment such as an electrical disconnect or an approved air valve. Energy Source Any electrical, mechanical, hydraulic, pneumatic, chemical, nuclear, thermal, or other potential energy source that could have the potential to endanger personnel. Energized Any machine or equipment that is connected to an energy source or containing residual or stored energy. Entry Point of Power The point at which energy enters the system, machine or unit, such as the main electrical disconnect. Energy Isolating Device A mechanical device that physically prevents the transmission or release of energy. Push buttons, selector switches, and other control circuit type devices are not energy isolating devices. Lockout The placement of a lockout device on an energy-isolating device, in accordance with an established procedure, ensuring that the energy-isolating device and the equipment being controlled cannot be operated until the lockout device is removed. Lockout Device A device used to lockout machinery or equipment by the means of a lock (either key or combination) in order to hold an energy isolating device from energizing. Included as lockout devices are blank flanges and bolted slip blinds. All lockout devices will be maintained in accordance to OSHA s 29 CFR 1910.147 and will have the following: Singularly identified and shall be the only device(s) used for controlling hazardous energy and shall not be used for any other purposes. All lockout equipment shall be durable and capable of withstanding the environment to which they may be exposed. All lockout and tagout equipment/devices shall be standardized within a facility in at least one of the following criteria: color, shape, or size. All lockout equipment will be substantial enough to prevent removal without the use of excessive force or unusual techniques. For example the use of a bolt cutter or other metal cutting material. 4

Lockout equipment will be identifiable and indicate on the lock itself through color or a tag specifically who applied the device. Tagout devices will warn against hazardous conditions if the machine or equipment is energized and shall include one of the following phrases: DO NOT START, DO NOT OPEN, DO NOT ENERGIZE, DO NOT OPERATE. Normal Production Operations The utilization of a machine or piece of equipment to perform its intended production operation or function. Other Employees All employees whose work operations are or may be in an area where control procedures to equipment or machinery may be utilized. Power Any type of energy that can operate equipment, cause movement, or cause injury directly from the energy source. Residual Electrical Power Electrical energy that may be stored or retained with the operations system of the machine or piece of equipment when the supply line is disconnected and the power is placed in the OFF position. Residual Pressure The differential pressure remaining within a component after the pressure source is closed off. Servicing or Maintenance Workplace activities such as constructing, installing, setting up, adjusting, inspecting, modifying, and maintaining and/or servicing machines or equipment. Tagout The placement of a tagout device on an energy isolating device in accordance with the established procedures to indicate that the energy isolating device and equipment being controlled may not be operated until the tagout device has been removed. Tagout Device A prominent warning device, such as a tag and means of attachment, which can be securely fastened to an energy isolating device to indicate that the machine or equipments energy isolating device is being controlled and operation can not occur until the tag has been removed. 1.3 Responsibility for Compliance All employees are required to comply with the restrictions and limitations imposed upon them during the use of lockout procedures. Employees authorized to lockout machines/equipment are required to perform the lockout in accordance with the specific procedures established for each machine and the procedures established by this program. Upon observing a machine, employees shall not attempt to start, energize, or use that machine/equipment while it is in the lockout/tagout stage. Failure to comply with this policy may result in disciplinary action. The Health & Safety Coordinator will be responsible for the following in regard to this program: Development and implementation of specific energy control policy for each machine identified in this program. Definition and procurement of authorized lockout and tagout devices. Training and performance review of employees on the lockout/tagout program and procedures. Maintain all training and work files in regard to this program. 5

Only purchase new equipment or machinery that can accommodate locks. If new equipment or machinery cannot accommodate locks, new lockout/tagout equipment will be purchased. Identify specific hazards and develop a hazard isolation procedure with the facility for each individual machine or equipment. Communicate and practice the facility s hazardous energy control policy and procedures with all employees in the work unit. Monitor hazard isolation procedures for effectiveness. No employee shall remove a lockout or tagout device affixed by another employee unless they have been authorized to do so. The person who affixed the original lockout and tagout device will be responsible for removal unless otherwise noted. When an incoming authorized employee is to assume lockout/tagout responsibilities on a piece of equipment from a departing employee due to a shift or personnel changes, the incoming employee shall affix his/her properly labeled lock or tag device to the equipment prior to that employee beginning work on that machine or equipment. The individual leaving the site due to a shift change or personnel change should not remove their lockout/tagout device until the individual replacing them has affixed their lock on the equipment or machine in repair. If there are any questions please contact the Facilities and Grounds Supervisor. 1.4 Energy Control Procedures A list of machinery and equipment has been developed and is available for review. This section outlines some of the general information on the basic procedures employees must follow in order to implement this hazardous energy program. Specific machinery procedures have been and are located under the Specific Written Procedures tab of this program. The employer does not need to document the required procedure for a particular machine or equipment, when all of the following elements exist: The machine or equipment being worked on has no potential for stored or residual energy or re-accumulation of stored energy after the shut-down process has been preformed, which could endanger an employee. The machine or equipment has a single source or energy, which can be readily identified and isolated. The machine equipment is isolated from that energy source and locked out during servicing or maintenance. A single lockout device will achieve a locked out condition. The isolation and locking out of the energy source will completely de-energize and deactivate the machine or equipment. The lockout device is under the exclusive control of the authorized employee performing the servicing or maintenance. The servicing or maintenance does not create a hazard for other employees. The District, in utilizing this exception, has had no accidents involving the unexpected activation or re-energization of the machine or equipment during which servicing or maintenance is being performed. Energy control procedures will clearly and specifically outline the purpose, rules, and techniques to be utilized when maintenance or servicing activities occur and lockout/tagout procedures must be implemented. These procedures will include the following: A specific statement of the intended use of the procedures. Specific procedural steps for shutting down, isolating, blocking and securing machines or equipment relative to the control of hazardous energy. Specific procedural steps for the placement, removal, or transfer of all lockout or tagout devices and the responsibility of them. 6

Specific requirements for testing a machine or equipment to determine and verify the effectiveness of the lockout devices, tagout devices and other energy control measures relative to the control for each piece of equipment/machine, of hazardous energy. Note: For specific District procedures please refer to the Specific Written Procedures of this program. 1.5 Equipment for Lockout/Tagout Within the District there are several categories of machinery and equipment in use. For the purpose of achieving lockout/tagout of this machinery, employees will be provided with appropriate lockout/tagout devices. Lockout devices shall be substantial enough to prevent removal without the use of excessive force or unusual techniques, such as bolt cutters or other metal cutting tools. Tagout devices including their means of attachment, shall be substantial enough to prevent inadvertent or accidental removal. Tagout device attachment means shall be of a non-reusable type, attachable by hand, self-locking, and non-releasable with a minimum unlocking strength of no less than 50 pounds and having the general design and basic characteristics of being at least equivalent to a one-piece, all environment-tolerant nylon cable tie. Warning tags will bear the name of the authorized person and the date of application. Tags are made to be durable, weather proof, and not easily damaged. Padlocks multiple padlocks are issued to all authorized employees. Padlocks are to be used for lockout purposes only. Locks and matching key(s) will be identified and assigned to each position. Only the authorized person may apply and remove their own lock. Key(s) may never be given to another person. Note: The district locksmith has additional copies of each key. There may be a rare circumstance where an additional key may be needed to remove a lock. (see: Appendix A Absent Person Removal of LOTO Device ) Lockout Clamps These devices are designed to accommodate more than one lockout padlock when one or more individuals are working on de-activated equipment. Each person, to assure his or her safety, will apply a lock and warning tag and remove it when the task has been completed. Warning Tags All authorized employees will be issued warning tags, which must be affixed and used whenever a padlock cannot be applied. The tag must be attached as closely as possible to the energy disconnect source. Extra caution will be exercised under these conditions since there is no physical restraint when only a tag is used and energy can be restored without the removal of a lock. Electricians may remove fuses but must attach a tag to the panel involved and remove the tag when the machine is ready for service and the fuse is replaced. Tag legends may include but are not limited to the following: DANGER Do Not Start DANGER Do Not Open DANGER Do Not Close 1.6 Sequence of Lockout DANGER Do Not Energize DANGER Do Not Operate DANGER Hands Off The following sequence of lockout should be followed when lockout/tagout procedures are needed to perform maintenance or servicing on machines or equipment: Lockout or tagout shall be performed only by the authorized employees who are performing the servicing or maintenance. 7

All authorized employees performing servicing/maintenance are required to notify the affected employee(s) of the application and removal of lockout/tagout devices. Notification will be given before the controls are applied, and after they are removed from the machinery or equipment. The established procedures for the application of energy control (the lockout tagout procedures) shall cover the following elements and actions and will be done in the following sequence: o Preparation for shutdown. Before an authorized or affected employee turns off a machine or equipment, the authorized employee will have the knowledge of the type of magnitude of energy, the hazards of the energy to be controlled, and the method or means of controlling all hazardous energy sources. o Machine or equipment shutdown. The machine or equipment will be shut down or turned to the off position using the procedures established for the machine or the equipment. An orderly shutdown must be utilized to avoid causing additional hazards that may develop as a result of equipment shut down. o Machine or equipment isolation. All energy isolating devices that are needed to control the escape of hazardous energy to the machine or equipment must be physically located and operated in such a manner as to isolate the machine or equipment from release of energy source(s). o Lockout or tagout application. Lockout or tagout device(s) must be affixed to each energy isolating device(s) by an authorized employee. When used, lockout devices must hold the energy isolating device in the off or safe position. o Stored energy. Following the application of lockout or tagout devices to energy isolating devices, all potentially hazardous stored or residual energy will be relieved, disconnected, restrained, and otherwise rendered safe. If there is a possibility of re-accumulation of stored energy to a hazardous level, verification of isolation will be continued until the servicing or maintenance is completed, or until the possibility of such accommodation no longer exists. o Verification of isolation. Prior to starting work on machines or equipment that have been locked out or tagged out; the authorized employee will verify that isolation and deenergization of the machine or equipment have been accommodated. NOTE: If a switch or disconnect cannot be locked out for any reason, an electrician must remove the fuse(s) before any work is started. If the fuse cannot be removed, tag-out regulations may apply. Stored or residual energy such as capacitors, springs, rotating fly wheels and hydraulic systems, and air, gas, steam, or water pressure lines must be dissipated or restrained by methods such as grounding, repositioning, blocking or venting. If there is a possibility of accumulation of stored energy, isolation must be verified continuously until servicing or maintenance is completed. When the machine is fully locked out, service and repairs can safely begin. If there are any doubts about the above procedures, the authorized employee shall contact their supervisor before proceeding. 1.7 Procedures for Group Lockout/Tagout When servicing and/or maintenance is performed by a crew, department or other group, they will utilize a procedure which affords the employees a level of protection equivalent to that provided by the implementation of a personal lockout or tagout device. Group lockout or tagout devices will be used in accordance with the procedures required in this policy, but not necessarily limited to, the following specific requirements: Primary responsibility is vested in an authorized employee for a set number of employees working under the protection of a group lockout or tagout; 8

Provision for the authorized employee to ascertain the exposure status of individual group members with regard to the lockout or tagout of the machine or equipment; and When more than one crew, department, etc. is involved, assignment of overall job-associated lockout or tagout control responsibility to an authorized employee designated to coordinate affected work forces and ensure continuity of protection; Each authorized employee will affix a personal lockout or tagout device to the group lockout device, group lockbox, or comparable mechanism when he or she begins work, and will remove those devices when he or she stops working on the machine or equipment being serviced or maintained. In situations where lockout/tagout devices must be temporarily removed from the energy isolating device and the machine or equipment must be energized to test or position the machine, equipment or component, the following actions shall be followed: Clear the machine or equipment of tools and materials. Remove employees from the machine or equipment area. Remove the lockout/tagout devices. Energize and proceed with testing or positioning. De-energize all systems and reapply energy control measures to continue with servicing and maintenance. Release stored energy (capacitors, springs, elevated members, rotating fly wheels, and hydraulic/air/gas/steam systems, etc.). 1.8 Restoring Equipment to Service When work has been completed, the following procedures must be followed in order to ensure safe removal and restart: 1. When the job is complete and the machine or equipment is ready for testing or normal service, check the equipment and/or circuits to insure that no one is exposed. 2. When the equipment and/or circuits are clear, remove all locks. The energy isolating devices may be operated to restore energy to the equipment and/or circuits. 1.9 Training Rochester Public Schools will provide training to ensure that the purpose and function of the energy control program are understood by employees and that the knowledge and skills required for the safe application, usage, and removal of the energy controls are acquired by employees. All training documentation will be updated and kept on file in the Health & Safety Coordinators office in the Maintenance Service Building. The training will include the following elements: Each authorized employee will receive training in the recognition of applicable hazardous energy sources, the type and magnitude of the energy available in the workplace, and the methods and means necessary for energy isolation and control. At a minimum, training will be conducted at the time of initial hire. All affected employees (custodians, grounds crew, etc.) are required to operate or use a machine or equipment to which servicing or maintenance is being performed under Lockout/Tag-Out procedures, or whose job requires them to work in an area in which such servicing or maintenance is being performed, will be trained in the recognition of Lockout/Tag-Out procedures. Training will be conducted at the time of initial hire. The training will consist of recognition that only trained and authorized employees will repair, replace or adjust machinery and equipment; understanding that affected employees may not 9

remove locks, locking devices or tags from machinery, equipment or circuits; the purpose and use of the lockout procedures. All other employees whose work operations are or may be in an area where energy control procedures may be utilized, will be instructed about the procedure, and about the prohibition relating to attempts to restart or reenergize machines or equipment which are locked out or tagged out. When tag-out systems are used, employees will be trained in the following limitations of tags: Tags are essentially warning devices affixed to energy isolating devices and do not provide the physical restraint on those devices that is provided by a lock. When a tag is attached to an energy isolating means, do not remove it without authorization of the authorized person responsible for it, and it is never to be bypassed, ignored, or otherwise defeated. Tags must be legible and understandable by all authorized employees, affected employees, and all other employees whose work operations are or may be in the area, in order to be effective. Tags and their means of attachment must be made of materials which will withstand the environmental conditions encountered in the workplace. Tags may evoke a false sense of security, and their meaning needs to be understood as part of the overall energy control program. Tags must be securely attached to energy isolating devices so that they cannot be inadvertently or accidentally detached during use. Employee Retraining Retraining will be provided for all authorized and affected employees whenever there is a change in their job assignments, a change in machines, equipment or processes that present a new hazard, or when there is a change in the energy control procedures. Additional retraining will also be conducted whenever periodic inspection reveals, or whenever the employer has reason to believe, there are deviations from or inadequacies in the employee's knowledge or use of the energy control procedures. The retraining will reestablish employee proficiency and introduce new or revised control methods and procedures, as necessary. Rochester Public Schools will certify that employee training has been accomplished and is being kept up to date. 1.10 Contractor Relations If outside personnel or contractors are to be engaged in activities covered under the scope of this program, they will be informed of the contents of this program, the way it functions, and other important details of the lockout/tagout program as it applies to the work being done. All contractors will be required to comply with the provisions and procedures of this program unless otherwise noted. In some cases the contractor will be responsible to inform the school district of their own lockout/tagout procedures. The exchange of this information will be documented and filed in the Health & Safety Coordinators office in the Maintenance Service Building. 1.11 Annual Periodic Inspections A comprehensive inspection/audit of the energy control procedures will be conducted by the Health & Safety Coordinator and/or the District s Health and Safety Consultant, The Institute for Environmental Assessment. This audit will be conducted on an annual basis to ensure that the facility is in compliance with OSHA and MDE requirements and procedures. The results of the annual inspection will be documented and stored in the Training Section of this Program. 10

1.12 Removal of Absent Persons LOTO Device/Locks Removing a LOTO device/lock by anyone other than the authorized employee is a last resort. Occasionally circumstances may require this procedure! In the event that there is a need to remove an employee s LOTO device or lock (Appendix A) Absent Person Removal of LOTO Device must be completed and signed off before removing the lock. 11

Rochester Public Schools ISD #535 PERIODIC INSPECTION OF ENERGY CONTROL PROCEDURES This form is used to inspect the energy control procedures for the following equipment/machine: Basic Information: (Complete/Compare with Existing Energy Control Procedures) Department: Building: Date: Location/Area: Inspector: Authorized Employees involved: Other employees affected: Service/maintenance activities requiring Lockout/tagout: Review the current Lockout/tagout procedures and indicate whether procedures are satisfactory. Any procedures marked NO must be explained under Comments/Deficiencies below: a. Control methods: Satisfactory? Yes No b. General Review of Responsibilities and Procedures: Satisfactory? Yes No c. Energy Identification: Satisfactory? Yes No d. Lockout Device: Satisfactory? Yes No e. Energy Release Methods: Satisfactory? Yes No f. Lockout Steps: Satisfactory? Yes No g. Comments/Deficiencies: Certification: This energy control procedure is adequate (or modified as noted above). The inspector has reviewed appropriate responsibilities with the Authorized Employee(s). Tag limitations were inspected and appropriate Affected Employees included in this review where tagout devices are used. Inspector's Signature: Authorized Employee's Signature: Date: Date: 12