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Department of Juvenile Justice and Delinquency Prevention

Hazardous Energy Control Procedural Posting

EQUIPMENT DESCRIPTION

LOCATION:

ENERGY TYPES: (CHECK ALL APPLICABLE)

GENERAL DESCRIPTION:
 
 
 

ELECTRICAL

 

STEAM

 

THERMAL

MANUFACTURER:

 
 
 

PNEUMATIC

 

CHEMICAL

 

GRAVITY

MODEL
NO.:

 
 
 

HYDRAULIC

 
 
 
 

SERIAL
NO.:

 
 
 
 
 
 
 
 

THE
FOLLOWING ENERGY CONTROL PROCEDURE WILL BE USED FOR
THE EQUIPMENT LISTED ABOVE.

 

Only AUTHORIZED employees will lockout or tagout this machine /
equipment.

 

AUTHORIZED employees will notify all AFFECTED and OTHER employees of application and removal
of lockout or tagout devices and ensure they understand conditions/restrictions/procedures.

 

The AUTHORIZED employee will verify the energy sources listed for
this machine/equipment.

 

1.

SHUTDOWN & ISOLATION

Shut down the machine and isolate its source using the controls or
services listed below in the order shown.

 
 
 
 
 
 
CONTROL/DEVICES
PURPOSE
Attach photo (where available)showing the labeled locations of shutdown/isolation
controls
described
in Section 1

of this form.

A.

 
 

B.

 
 

C.

 
 

D.

 
 

E.

 
 

2.

LOCKOUT/TAGOUT

Apply your lock and / or tag. Be sure that it holds
the isolating device in the OFF OR SAFE position.

 

3.

RELEASE

The AUTHORIZED employee shall
ensure all stored or residual energy (such as that in capacitors, springs,
air, gas, steam, or water pressure, etc.) is dissipated or restrained
by methods such as grounding, repositioning, blocking, bleeding down,
etc.

 

RESTART
PROCEDURES

 
 

When the servicing or maintenance is completed machines / equipment
are ready to return to normal operating condition, the AUTHORIZED employee shall:

INSPECT

Check the machine/equipment and the immediate area
around it to ensure that it is operationally intact.

4.

VERIFY

Prior to starting work on machines / equipment that
have been locked out or tagged out, the AUTHORIZED employee shall
ensure that they are energy source(s) by:

NOTIFY

Check the work area to ensure that all employees have been safely
positioned or removed from the area.

 

REMOVE

Verify that controls are in neutral.

Remove lockout/tagout devices and/or energy isolation
devices in reverse order to which they were installed.

Re-energize the machines / equipment.

1.

Checking that personnel are clear of machine/equipment

2.

Operating the push button on other normal operating
control(s) or testing to make certain the machines / equipment will
not operate.

RELEASE

Notify AFFECTED and OTHER employees that the
servicing or maintenance is completed and the machines / equipment is
ready to use.

CAUTION

 

RETURN OPERATION CONTROL(S) to NEUTRAL OR OFF
POSITIO