LOCKOUT/TAGOUT PROGRAM FOR

MACHINES AND EQUIPMENT

Clemson University

Environmental Safety and Health

Last Revised September 2016

 I. INTRODUCTION

The Clemson University (CU) Lockout/Tagout (LO/TO) program designates practices

and procedures to prevent injury to employees who service or maintain machines or
equipment capable of unexpected energizing, startup, or release of stored energy. Such
equipment must be locked and tagged-out or tagged-out prior to conducting service or
maintenance.

Lockout devices are designed to form a physical barrier between the equipment and its
energy source thereby preventing operation. Lockout devices are used in conjunction
with tagout devices. Some equipment, particularly older equipment, may not be designed
to accommodate a lockout device. In such cases, warning tags, also referred to as tagout
devices, are affixed to the equipment to alert people not to energize the equipment.
Tagout devices, when used alone, do not physically prevent accidental start-up.

The terms “equipment” and “machines” have broad meanings in the context of this
document and are used interchangeably. Equipment may include such things as air
handlers (building HVAC systems), elevators, steam or sewer lines, and other utilities.
The term equipment may also be used in the more traditional fashion when referring to
things like lathes, presses, drills, etc. While it is common to think of equipment and
machines as having an electrical energy source, they may be associated with other types
of energy sources including hydraulics, pneumatics, mechanical, gravity, thermal,
chemical, fluids and gases, water under pressure, or steam. The terms “service” and
“maintenance” are also used interchangeably for the purposes of this document.

Questions regarding this policy should be directed to Environmental Health and Safety:

Ryan Wagner
[email protected]
(864) 643-6130

II. REGULATORY AUTHORITY

The CU LO/TO program is designed to ensure compliance with the Federal Occupational
Safety and Health Administration (OSHA) standards on the Control of Hazardous
Energy, 29 CFR 1910.147 (General Industry Standard) and 29 CFR 1928.57
(Agricultural Operations).

III. SCOPE
The focus of the CU LO/TO program is equipment/machines. This program does not
apply to work conducted on high voltage electrical supply and distribution systems. In the

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case of certain equipment or machines, additional LO/TO requirements may apply under
other OSHA standards (i.e., cranes/hoists, cement finishing tools, etc.).

The CU LO/TO program applies to all CU employees that service or maintain covered
machinery or equipment. Contractors are required to develop, implement, and maintain
their own LO/TO program that meets or exceeds minimum OSHA requirements when
conducting work for CU.

The CU LO/TO program is applicable to tasks or situations requiring or involving:

• Placement by an employee of any body part into or near a machine’s point of
operation or the danger zone associated with the machine’s operation.
• Constructing, installing, setting-up, cleaning, lubricating, adjusting, inspecting,
modifying, maintaining, and/or servicing machines or equipment.
• Clearing blocked or jammed equipment.
• Removing or bypassing a guard or other safety device.

Specific examples of equipment that may be subject to the CU LO/TO program during
service, maintenance, or set-up configuration changes are listed below. This list is
demonstrative – it is not inclusive.
• Condensate lines.
• Power tools such as lathes, saws, presses.
• Autoclaves.
• Tractors and associated PTO equipment.
• Elevators.
• Lasers.
• Printing presses.
• HVAC systems.
• Pneumatic tools.
• Miscellaneous fans, motors, etc.

Not all equipment or machines are subject to the full requirements of this program. In
general, a piece of equipment that does not store energy and that can readily be
disconnected from its energy source (i.e., key removed, unplugged, etc.) is not subject to
the requirements of this LO/TO program (Section X).

IV. PROGRAM SUMMARY

Under the provisions of CU LO/TO program, certain requirements must be met prior to
servicing or repairing certain equipment. In particular, employees and/or their supervisors
are required to follow established generic procedures or develop equipment-specific,
written energy control procedures (Section V), participate in training (Section VII), and
ensure that periodic inspections of energy control procedures and authorized employees
are performed and documented (Section VIII). Employees and their supervisors must also
be familiar with other elements of the program such as the requirements for work
conducted on covered equipment by outside contractors, group LO/TO procedures when
service or maintenance activities are performed by a crew, craft, department, or other

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group (Section V), responsibilities (Section IX), and exemptions to the CU LO/TO
program (Section X).

Additional instruction/guidance material is contained in the appendices, which include

definitions (Appendix A), energy control procedure template (Appendix B), and energy
control procedure review form (Appendix C).

V. PROCEDURES
Two general and four specific supplemental LO/TO procedures are discussed in this
section. The two general procedures, which address most tasks/equipment encountered at
CU, provide instructions for single-point lockout/tagouts. These general procedures,
depending on specific circumstances, may need to be modified by incorporating specific
procedures related to group lockout/tagout, work by outside contractors, lockout/tagout
during shift or personnel changes, and removal of another employee’s lock. Where
multiple-point lockouts or tagouts are necessary, written equipment-specific procedures
must be developed and implemented by authorized employees and their supervisors.

All procedures, including but not limited to the general procedures described below and
equipment-specific procedures must include the following steps:

1) Refer to procedure to ensure method of shutdown and proper isolation points

2) Communicate with affected employees and prepare for shut-down;
3) Shutdown the machine/equipment using normal stopping procedure;
4) Disconnect or isolate the machine from its hazardous energy source(s);
5) Apply the lockout or tagout device(s) to the energy-isolating device(s);
6) Release, restrain, or otherwise render safe all potential hazardous stored or
residual energy; and if the possibility exists for re-accumulation of hazardous
energy, regularly verify during the service and maintenance that such energy
has not re-accumulated to hazardous levels;
7) Verify the isolation and de-energization of the machine;
8) Complete the servicing or maintenance required and then clear work area of all
employees, tools and employees. Verify that all guards and other type of components
have been restored to their original condition;
9) Remove lockout devices and communicate with affected employees and prepare for
returning the machine to service.
10) Return machine to service and verify functionality of machine/equipment.

A. General Procedures
1. Single-Point Lockout
The following procedure is appropriate when servicing equipment that can be
isolated from its hazardous energy source by the lockout of a single, readily
identifiable isolation device, and there is no potential for re-
accumulation/residual/stored energy after the equipment has been locked out. In
this case, a supplemental, equipment-specific, written procedure may not be
required. Please consult EHS in this instance.

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  The authorized employee shall inform affected employees that service or
maintenance is required on the equipment and that it must be shut down,
locked out, and tagged.
 If the equipment is operating, the authorized employee will shut it down
using the normal shutdown procedure (i.e., depress the stop button, open
the switch, close the valve, etc.).
 The authorized employee will isolate the energy source (i.e., turn off the
breaker, apply blind flanges on a pipe, etc.).
 The authorized employee will lock out the energy-isolating device with
their lock and attach a tag to the lock or hasp. The tag should have the
name of the employee affixing the tag, and the date and time the tag was
affixed.
 The authorized employee will ensure that stored or residual energy (such
as that in capacitors, springs, elevated machine members, rotating
flywheels, hydraulic systems, and air, gas, steam, or water pressure) is
dissipated or restrained by methods such as grounding, repositioning,
blocking, or bleeding down.
 The authorized employee will verify that the equipment is disconnected
from the energy source. After confirming that no one is exposed to the
hazardous energy source/machine, the authorized employee will verify
that the equipment is isolated and residual or stored energy is
dissipated/restrained by activating the start button/switch or other
operating control(s), or by testing the equipment with properly operating
and/or calibrated equipment (i.e., voltmeter). Following
testing/verification, the authorized employee will return the operating
control(s) to the neutral ("off") position. Authorized employees must
ensure the integrity of the lockout/tagout procedure following any
extended absence.
 When the equipment is ready to be returned to service, the authorized
employee should check the equipment and the immediate area to ensure
that nonessential items have been removed, that all components are
operationally intact, and that all guards or other protective features are
restored.
 The authorized employee will check the work area to ensure that all
personnel are safely positioned away from the equipment, and verify that
the controls are in the neutral, off, or safe position.
 The authorized employee will remove their lockout device and associated
tag, re-energize the equipment, and notify affected employees that work is
complete and the equipment is ready to return to service.

Removal of some forms of blocking devices may require re-energizing the

machine before maintenance is complete (i.e., the equipment must be energized to
test or position any of its components prior to return to normal service). If the
lockout device or tag must be temporarily removed from the energy-isolating
device, the authorized employee must follow the sequence of actions below:

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  Clear the equipment of tools and materials and have all non-
authorized employees leave the equipment area;
 Remove the lockout from the energy-isolating device;
 Energize the equipment and proceed with testing or positioning;
 De-energize all systems and reapply the energy control measures.
Continue service and/or maintenance activities;

3. Multiple-Point Lockout/Tagout
Equipment-specific, written procedures must be developed and implemented
for equipment with multiple isolation points or that otherwise does not meet
the conditions for single-point lockout/tagout. The written procedure must
identify all the hazardous energy sources for the equipment item or process,
and the technique(s) required to isolate each source. An authorized employee
or their supervisor must develop the procedure. If developed by an authorized
employee, their supervisor must approve the procedure. The Energy Control
Procedures Template in Appendix B can be used to develop and document the
procedure.
B. Specific Procedures
1. Group Lockout/Tagout
This supplemental procedure is applicable when more than one employee will be
simultaneously servicing the same piece of equipment. Equipment-specific,
written procedures must be developed and implemented for a group lockout. The
written procedure must identify all hazardous energy sources for the equipment
item or process, and the technique(s) required to isolate each source. An
authorized employee or their supervisor must develop the procedure. If
developed by an authorized employee, their supervisor must approve the
procedure. The Energy Control Procedures Template in Appendix B can be used
to develop and document the procedure. The general process that must be
followed is described below and must be incorporated into the written,
equipment-specific procedure.
 An authorized employee, designated by the supervisor as the group lead,
shall inform affected employees that service or maintenance is required on
the equipment and that it must be shutdown, locked out, and tagged.
 The group lead authorized employee will shut down the equipment using
the normal shutdown procedures (i.e., activate the stop button, open the
switch, close the valves, etc.). Specific shut-down operations should be
described in the written procedure.
 The group lead authorized employee will isolate all sources of energy (i.e.,
turn off the breaker, apply blind flanges on a pipe, etc.). Specific energy
sources and isolation operations should be described in the written
procedure.
 The group lead authorized employee will attach a group lock and tag on
each isolation point.
 The group lead authorized employee will place the key to the group locks
into a lockbox under the supervision of at least one other authorized

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 employee or supervisor. The group lead authorized employee will then
place their employee lock and tag on the box as well as a tag. The group
lead authorized employee will also attach a tag showing that they are group
lead to their lock.
 The group lead authorized employee will test the equipment to verify the
effectiveness of the lockout device with all authorized employees involved
in the lockout/tagout, if applicable. Specific test procedures should be
described in the equipment-specific lockout/tagout procedure.
 Each authorized employee should visually inspect the isolation of the
equipment and confirm zero energy, when satisfied that it is correctly and
safely isolated, place their lock on the hasp/box prior to beginning work.
When an authorized employee completes their work, they are responsible
for removing their lock from the lockbox.
 When the equipment is ready to be returned to service the group lead
authorized employee should check the equipment and the immediate area
to ensure that nonessential items have been removed, that all components
are operationally intact, and that all guards or other protective features are
restored.
 The group lead authorized employee will check the work area to ensure
that all personnel are safely positioned away from the equipment.
 The group lead authorized employee will verify that the controls are in the
neutral, off, or safe position.
 All authorized employees will remove their locks from the lockbox.
 The group lead authorized employee will remove the group locks, and
associated tags, remove their lock and associated tags last from the
lockbox.
 The group lead authorized employee will notify affected employees that
work is completed and the equipment is ready to be returned to service.
 Equipment is now ready to be reenergized and verified.

2. Contractors
Outside contractors or vendors performing service, maintenance, and/or
construction work at CU are required to have in place and follow their
Lockout/Tagout Program. Project Managers of both capitol and minor projects are
responsible for overseeing contractors to verify compliance with this requirement.
Departments that hire and supervise contractors directly are responsible to verify
compliance with this requirement (i.e., equipment or service maintenance
contracts).

Note: Other information may need to be exchanged at this time (i.e., Chemical
Safety, Confined Space Program, etc.)
When outside service personnel (i.e., independent contractors or service vendors)
are to be engaged in a group lockout with CU employees, CU authorized
employees will follow the CU Lockout/Tagout Program for group lockouts and
contractors will apply their locks to the lockbox hasp. Communication

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 between/among groups must take place to ensure all affected and authorized
employees are protected.

3. Shift or Personnel Changes

To maintain continuity in the protection provided for those involved in the
lockout/tagout procedures, and for the orderly transfer of the lockout/tagout
devices, the steps below are necessary during personnel or shifts changes.
 Personnel Changes. The arriving authorized employee's lock
and tag should be applied before the departing authorized
employee's lock and tag are removed. The departing personnel
will inform the arriving personnel of the status of the
equipment and the work in progress.
 Group Lockout Shift Changes. The lock and tag of at least one
authorized employee on the arriving shift should be applied
before the last crewmember of the departing crew removes
their lock. The departing crew will inform the arriving crew of
the status of the equipment and the work in progress. The
arriving crew will verify zero energy before beginning work.

4. Removal of Another Employee’s Lock

When the authorized employee who applied the lockout devices and associated
tags is not available to remove them, the devices may be removed by the
authorized employee's supervisor in accordance with the process described below:
 The authorized employee's supervisor must verify that the
authorized employee who applied the lockout device(s) and
associated tag(s) is not on duty and that their work is no longer
in progress by taking all reasonable efforts to contact the
authorized employee to inform him/her that the devices need to
be removed.
 An authorized employee/supervisor returns the equipment to
service and notifies the affected employees that service or
maintenance is completed and the equipment is ready for use.
 When the employee returns to work, the supervisor notifies
him/her that their lock(s) and tag(s) were removed.
 If employee is present but has lost key to lock, lock may be
removed by cutting the lock.
All lock removals must be approved by EHS or department
supervisor.

Locks must never be removed without verifying that the authorized employee has
cleared the work area/hazard zone.

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VI. EQUIPMENT
A. Protective Materials and Hardware
Locks and tags used for lockout/tagout must be easily recognizable as locks or
tags used for lockout/tagout purposes. Locks must be red in color and of the same
shape, or size (uniquely identifiable), this lock style must only be used for lock
out purposes. Tags should be plastic; red, white, and black in color; and labeled
with the words “Danger, Do Not Operate,” or equivalent.
Supervisors are responsible for providing authorized employees under their
supervision with locks and tags and any special chains, wedges, key blocks,
adapter pins, self-locking fasteners, or other hardware required for isolating,
securing, or blocking equipment from energy sources. These materials must be of
durable construction and capable of withstanding the conditions in which they are
placed. Locks must only be used for lock out purposes and not for any other
purpose i.e. locker or tool box.
B. Lockable Energy-Isolating Device Installation
Whenever possible, equipment that is not capable of receiving a lockout device
should be retrofitted to accommodate a lock. Newly purchased equipment must be
capable of accommodating a lockout device.

VII. TRAINING
A. Authorized Employees and their Supervisors
Upon request, Environmental Health and Safety (EHS) will provide or arrange for
Lockout/Tagout training to include information on the recognition of applicable
hazardous energy sources, the type and magnitude of the energy available in the
workplace, and the methods and means available for energy isolation and control.
The training will cover the requirements of the CU Lockout/Tagout Program.
Supervisors must supplement this general training with equipment-specific
training for authorized employees under their direction.
B. Equipment Specific Lockout/Tagout Training
Supervisors are responsible for developing and/or approving equipment-specific
lockout/tagout procedures, as well as associated employee training. Equipment-
specific training can be accomplished by presenting applicable written procedures
to authorized employees, assuring that they understand the requirements of the
procedure, and observing correct performance of the procedure(s).
C. Affected Employees
Training for affected employees is accomplished in two ways: 1) those employees
who participate in EHS Core Training are informed of the CU lockout/tagout
program, and instructed that they must never attempt to restart equipment that is
locked out or tagged out and to not tamper with locks, tags or lock out devices; 2)
prior to initiating service and the lockout/tagout procedures, authorized employees
must inform affected employees of their activities and that they are not to restart
the equipment, remove tags or locks, or otherwise engage in any equipment-

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 related activity until the service is complete and they are so notified by the
authorized employee.

D. Retraining
Retraining is required when:
• There is a change in task assignment that involves use of different LO/TO
procedures than for which the authorized employee has been previously
trained;
• There is a change in the machine, equipment or processes that presents new
hazards;
• There is a change in the energy control procedures;
• The supervisor has reason to believe or determines through a periodic
inspection or observation that an authorized employee has deviated from or
lacks sufficient knowledge of established procedures.

VIII. RECORDKEEPING
A. Periodic Review
Supervisors of authorized employees must annually review (prior to use of a
newly-developed or revised written procedure and annually thereafter) written
procedures and observe implementation of the procedures by each authorized
employee. The purpose of this review is to ensure that the procedures are
adequate and that they are understood and followed by each employee.
Supervisors may delegate review authority to another authorized employee other
than the one using the specific procedure, but the supervisor remains accountable
for the outcome of the review. Reviews must be documented. The Energy Control
Procedure Review form in Appendix C can be used to document procedure
reviews. The supervisor or department should maintain records of the most recent
review of each machine/equipment and send copies to EHS [email protected].

B. Training
EHS will maintain training records of general LO/TO training, if training is
conducted by our office. If general training is obtained elsewhere, supervisors or
departments are responsible for maintaining general training records and sending
copies to EHS [email protected]. Supervisors or departments must maintain
equipment-specific training records.

IX. RESPONSIBILITIES
A. Environmental Health and Safety (EHS)
 Develop, review, and update the CU Lockout/Tagout Program.
 Provide or arrange for general Lockout/Tagout training, upon request.
 Provide technical guidance, upon request.
 Periodically audit program to ensure compliance (no less than annually).

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 B. Department Heads/Chairs
• Support implementation of all aspects of the LO/TO program.
• Provide the resources necessary for implementing the LO/TO program.
• Ensure that outside contractors implement a LO/TO program while
conducting relevant work in the department.

C. Supervisors of Authorized Employees

 Ensure full implementation and compliance with the CU LO/TO program
within their area of supervision.
 Complete annual audits/reviews of each employee performing a lock out, this
task may be delegated to another authorized employee.
 Participate in LO/TO training.
 Ensure that all authorized employees under their supervision participate in
general LO/TO training.
 Provide authorized employees with equipment-specific, written LO/TO
procedures and training; maintain associated records.
 Review and approve all equipment-specific LO/TO written procedures before
use and annually thereafter; maintain associated records.
 Provide authorized employees with the necessary LO/TO equipment, such as
locks and tags, chains, wedges, blank flanges, key blocks, adapter pins, self-
locking fasteners, or other hardware as required by the written procedure for
isolating, securing, blocking, or dissipating energy sources on a specific piece
of equipment.
 Remove lockout/tagout devices of employees under their supervision when
necessary.
 Investigate and report any lockout/tagout accidents or near misses to EHS.
 Coordinate implementation of supplemental LO/TO procedures, such as group
LO/TO, contractor CU LO/TO, shift or personnel changes, and removal of
another employee’s lock/tag.

D. Authorized Employees
• Participate in LO/TO training and retraining, as required.
• Notify affected employees of LO/TO prior to servicing and upon completion
of service on covered equipment.
• Perform general and supplemental LO/TO procedures in accordance with
CU’s LO/TO program; adhere to supervisor-provided, equipment-specific
LO/TO procedures.
• As instructed by a qualified supervisor, coordinate with other authorized
employees during group LO/TO, contractor/MSU LO/TO, and shift or
personnel changes.
• Report any LO/TO accidents or near-misses to their supervisor.

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E. Affected Employees
• Never remove a lock or tag, or otherwise energize or operate any controls on a
machine that has been locked or tagged out.
• Adhere to all instructions provided by authorized employees or their
supervisors with regard to LO/TO procedures.
• Do not conduct any maintenance or service activities requiring the use of
LO/TO procedures without first being designated as an authorized employee,
participating in applicable training, and adhering to all provisions of the CU
LO/TO program.
• Report LO/TO accidents or near-misses to their supervisor.

F. Facilities Management Department

• Ensure that outside contractors hired by Project Mangers implement a LO/TO
program while conducting work at CU.
X. EXEMPTIONS AND GLOBAL SPECIFIC PROCEDURES

A. Cord/Plug Equipment
Work on an electrical cord and/or plug-connected equipment is exempt if
exposure to the hazards of unexpected energization or start up of the equipment is
controlled by unplugging the equipment from the energy source, and if the plug is
under the exclusive control of the employee performing the service or
maintenance activity. Pneumatic tools may also fall into this category provided
that they can be completely isolated from their energy source and bled of stored
energy.
B. Lasers
Alignment of lasers is exempt, provided that appropriate PPE (eye protection and
skin protection, when necessary) is worn by all persons in the room.
C. Hot Tap Operations
Hot tap operations performed on pressurized transmission or distribution systems
for gas, steam, water, or petroleum products are exempt, provided that the
supervisor can demonstrate:
• Continuity of service is essential.
• Shutdown of the system is impractical.
• Documented procedures are reviewed and approved by EHS prior to initiating
the work.
D. Grain Bins
Emptying of flat-bottom, farm-style, grain bins is exempt, provided that no body
part comes in contact with the sweep auger and all fans are guarded.
E. Ignition Key Control
Motorized equipment (automobile, tractor, mowers, forklift, etc.) is exempt
during repair or service, provided that the operator has the only key on their body,

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 the engine is shut-off, the brake is set, and a tag is attached to the steering wheel.
If energization is possible even with the key removed, the negative battery cable
must also be disconnected prior to commencing service or maintenance work.
Where applicable, motorized equipment must also be isolated from other
hazardous energy sources (i.e., hydraulic oil pressure, mechanical, blocking of
equipment to prevent equipment from falling, etc.).
F. Other
Other exceptions may be applicable to specific equipment. EHS will, upon
request, review specific equipment for applicability of exclusions.

Appendix on pages 13-18

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Appendix A- 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 such
servicing or maintenance is being performed.

Authorized employee – A person who locks or tags out machines or equipment in order
to perform service or maintenance.

Capable of being locked out – An energy-isolating device is capable of being locked out
if it has a hasp or other means of attachment to which, or through which, a lock can be
affixed, or it has a locking mechanism built into it. Other energy-isolating devices are
capable of being locked out, if lockout can be achieved without the need to dismantle,
rebuild, or replace the energy-isolating device or permanently alter its energy control
capability.

Energized – Connected to an energy source or containing residual or stored energy.

Energy-isolating device – A mechanical device that physically prevents the transmission
or release of energy, including but not limited to the following: a manually operated
electrical circuit breaker; a disconnect switch; a manually operated switch by which the
conductors of a circuit can be disconnected from all ungrounded supply conductors, and
in addition, no pole can be operated independently; a line valve; a block; and any similar
device used to block or isolate energy. Push buttons, selector switches and other control
circuit type devices are not energy-isolating devices.

Energy source – Any source of electrical, mechanical, hydraulic, pneumatic, chemical,

thermal, gravity, steam, fluids or gases under pressure, radiation, or other energy.
Equipment – Includes but is not limited to machines (lathes, presses, etc.), facility
mechanical systems (air handlers, elevators, utility lines, etc.), research equipment,
equipment components, and agricultural equipment.

Employee supervisor – An individual administratively in charge of an authorized

employee assigned to perform maintenance or service requiring the use of locks or tags.
Group Lock – A set of identical locks, all keyed identically, and used only for a group or
crew lockout.

Group lead- Refers to an authorized employee who has been designated the
responsibilities of leading a group lock out by a supervisor.

Hot tap – A procedure used in maintenance and service activities that involve cutting
and/or welding on a piece of equipment (pipelines, vessels or tanks) under pressure, in
order to install connections or appurtenances. It is commonly used to replace or add
sections of pipeline without the interruption of service for air, gas, water, steam, and
petrochemical distribution systems.

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Lockbox – A toolbox style box of rugged construction that is capable of receiving a hasp
when the box is shut. When the hasp is attached, a person cannot enter the box until the
hasp is removed.

Lockout – The placement of a lockout device and tag on an energy-isolating device, in

accordance with an established procedure that ensures that the energy-isolating device
and the equipment being controlled cannot be operated until the lockout device is
removed.

Lockout device – A device that utilizes a positive means such as a key operated padlock
to hold an energy-isolating device in the safe position and prevent the energizing of a
machine or equipment.

Servicing and/or maintenance – Workplace activities such as constructing, installing,

setting up, adjusting, inspecting, modifying, maintaining and/or servicing machines or
equipment. These activities include lubrication, cleaning, unjamming of machines or
equipment, and making adjustments or tool changes, where the employee may be
exposed to the unexpected energization or startup of the equipment or release of
hazardous energy.

Setting up – Any work performed to prepare a machine or equipment to perform its

normal operation.

Tagout – The placement of a tagout device on an energy-isolating device, in accordance

with an established procedure, to indicate that the energy-isolating device and the
equipment being controlled may not be operated until the tagout device is removed.

Tagout device – A prominent warning device, such as a tag with a means of attachment,
which can be securely-fastened to an energy-isolating device in accordance with an
established procedure to indicate that the energy-isolating device and the equipment
being controlled may not be operated until the tagout device is removed.

Testing – A determination that machinery, equipment, or equipment parts are de-

energized. This involves the use of properly operating test equipment designed for and
capable of determining if any energized conditions exist.

Verification – Operation of equipment controls for the purpose of determining that

equipment cannot be restarted after an energy-isolating procedure has been performed
and before maintenance or repair work is initiated.

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Appendix B

LOCKOUT/TAGOUT PROGRAM EQUIPMENT ENERGY CONTROL PLANNING PROCEDURE

Equipment: Ser #:
Mfg: Location:
Purpose: This procedure establishes the minimum requirements for lockout of energy
sources that could cause injury to personnel. All employees shall comply with the
Responsibility: The responsibility for seeing that this procedure is followed is incumbent
upon all employees. All employees shall be instructed in the safety significance of the
lockout procedure by their supervisor or manager. Each new or transferred affected
employee shall be instructed by their supervisor or manager in the purpose and use of the
lockout procedure.

Preparation for Lockout: Employees authorized to perform lockout shall be certain as to

which switch, valve, or other energy isolating devices apply to the equipment being locked
out. More than one energy source (electrical, mechanical, or others) may be involved. Any
questionable identification of sources shall be cleared by the employees with their
supervisors or managers.
E NERGY S OURCE I SOLATION D EVICE ( S ) L OCATION ( S )
Electric
Pneumat ic
Hydraulic
Gravit y
Mechanical
Thermal
Chemical
Other
P OTENTIAL H AZARDS :
Remember to Release All Stored Energy and notify Supervisor after lockout
but before starting work.

S HUTDOWN P ROCEDURE : S TART - UP P ROCEDURE :

Restoring Equipment to Service: When the job is complete and equipment is ready for
testing or normal service, check the equipment area to see that no one is exposed. When the
equipment is clear, remove all locks. The energy isolating device may be operated to
restore energy to the equipment.
Rules for Using Lockout Procedure: All equipment shall be locked out to protect against
accidental or inadvertent operation when such operation could cause injury to personnel.
Do not attempt to operate any switch, valve, or other energy isolating device bearing a lock.

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Review the following exceptions to determine if you must use or write a specific procedure
for this LOTO action. MARK EACH BOX IF IT APPLIES:

The machine or equipment has no potential for stored or residual energy or re-accumulation
of stored energy after shut down which could endanger employees

The machine or equipment has a single energy source which can be readily identified and
isolated

The isolation and locking out of that energy source will completely de-energize and
deactivate the machine or equipment

The machine or 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 lockout device is under the exclusive control of the authorized employee performing the
servicing or maintenance

The servicing or maintenance does not create hazards for other employees

The employer, in utilizing this exception has had no accidents involving the unexpected
activation or re-energization of the machine or equipment during servicing or maintenance

IF ALL BOXES ARE CHECKED – YOU DO NOT HAVE TO WRITE A SPECIFIC PROCEDURE
FOR THIS LOTO ACTION.
If at least one box is unchecked and there are no procedures already written for this LOTO requirement,
complete the other side, make a copy for your supervisor, and post this procedure on or near the equipment
in a plastic sleeve.

Signature of employee
who provided this
information:
Print Name: Date
Signature of employee
who provided this
information:
Print Name: Date:
Signature of employee
who provided this
information:
Print Name: Date:

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Appendix C- Energy Control Procedure Review Form
This form is used to conduct and document periodic inspections of equipment-specific
energy control procedures. In the space below, record the unique procedure reference
number and the equipment description (see Appendix B):

Unique Procedure Reference Number: _____________________________________

Equipment/Machine/Utility Reference: _____________________________________
Equipment/Machine Location: ____________________________________________
Reviewed By/Date: _____________________________________________________
Authorized employee(s) observed (if necessary, attach additional sheet): ___________
_____________________________________________________________________
Review the current lockout/tagout procedures and indicate whether procedures are
satisfactory. Any item marked No must be explained (use the back of the inspection form
to record explanations).
Satisfactory?
1 Has the equipment specific procedure been reviewed within the
past 12 months? _____Yes ___No
2 Were affected employees informed by the authorized employee
prior to initiating service/maintenance? _____Yes ___No
3 Equipment shut down? _____Yes ___No
4 Equipment isolated following written procedure? _____Yes ___No
5 Equipment locked/tagged out (tag properly filled out)? _____Yes ___No
6 All energy bled-off or reduced to a zero energy state? _____Yes ___No
7 Isolation and de-energization verified? _____Yes ___No
8 Operating controls returned to neutral or off position? _____Yes ___No
9 Equipment area checked prior to removing locks/tags?
• Non-essential items removed
• Components operationally intact
• Guards or other protective features restored _____Yes ___No
• Area cleared of non-essential personnel
• Controls in neutral or off position

10 All affected employees notified that work was completed? _____Yes ___No
11 Other? _____Yes ___No
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: ____________________________________ Date: __________

Authorized Employee's Signature:___________________________ Date: __________

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