Workplace Lockout/Tagout Procedure Form

Workplace Lockout/Tagout Procedure Form

Date

[28/11/2050]

Time

[09:00 AM]

Equipment Name/ID

[Hydraulic Press HP-2001]

Department

[Production]

Performed By

[Your Name]

Supervisor

[Name]

Procedure Steps:

  1. Notification: Notify all affected employees that a lockout/tagout procedure is going to be implemented and the reason for it.

  1. Identification: Clearly identify the equipment or machinery to be locked out.

  1. Shutdown: Turn off the equipment following the standard shutdown procedure.

  1. Isolation: Isolate the equipment from its energy source(s).

  2. Lockout/Tagout Application: Apply lockout/tagout devices to each energy isolation point.

  1. Stored Energy: Ensure that any stored energy (electrical, mechanical, hydraulic, etc.) is released or restrained.

  1. Verification: Verify that the equipment is isolated from its energy source by attempting to operate it.

Lockout/Tagout Devices Used:

  1. Locks: [2 heavy-duty padlocks]

  2. Tags: [2 warning tags ("Do Not Operate")]

  3. Chain: [1 metal chain (4 feet)]

Additional Notes:

The hydraulic press has been reported to have irregular pressure fluctuations.

Extra caution is advised while handling the press post-maintenance.

Performed By:

                              

[Your Name]

[12/01/2050]

Supervisor:

                              

[Your Name]

[12/01/2050]

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