LOTO procedures example.pdf

Procedure Title: OE-14-AHU107 JHF 06-21-2023

Lockout/Tagout Procedure Form

Instructions: The Authorized Employee and the Program Administrator will complete this digital, fillable form for each piece of equipment separately. This form should inventory all energy sources and LOTO points for each piece

Procedure Description

Equipment Description: Air handling Unit 107

Serial Number:

CAXM XT016

Location of Equipment:

S510 (5R)

Area or Department:

Operations

Number of Lockout Points:

Lockout Device(s) Needed:

Circuit Breaker type, Clamshell type & padlocks

Lockout Procedure:

Shut down unit from ECC.

Move disconnect switches to OFF position on VFD's for AHU, lock & tag.

Open breaker on panel EQPD-2 #17, lock & tag.

Move Disconnect for Supply Fan to OFF position. Lock & Tag.

If applicable close Chilled Water valves CHWS & CHWR #1013, Steam Valve MPS #1010, Low Pressure Clean

Steam LPCS #1028, lock & tag.

Photos of lockout points in (S:) Drive>Engineering>Operations>Control of Hazardous Energy>

Documents>procedure forms>AHU Control of Hazardous Energy Lockout Procedures

Procedure to Verify Lockout is Complete:

Clear all personnel from danger zone, be sure to check isolated equipment is secured correctly before beginning task.

Verify main disconnect switches & breakers cannot be moved to ON position.

Move all power switches to "off or neutral" position.

Attempt to activate operating controls to ensure power is off.

Inform workers task is about to begin.

Date Written:

21 June 2023 Procedure Written By:

John Foisia Date Revised:

Date Reviewed: Reviewing Personnel:

Date Approved: Approvals:

Release and Start Up Procedure:

Clean up & inspect area of debris.

Where applicable remove isolation devices then SLOWLY open steam and/or water valves to protect coils from damage.

Remove locks, return Breaker Switches & Disconnects to ON position.

Remove locks, return VFD disconnects to ON position.

Contact ECC that all locking devices are removed & points of isolation are returned to ON position and can restart AHU.

VISN 2 Lockout/Tagout Written Program

Equipment-Specific Procedure

Facility Name: Syracuse VA Medical Center Date: 21 June 2023

Machine Identification

General Description: Air Handling Unit 107 serves 4th floor of SCI wing

Manufacturer: YORK Solutions XT Johnson Controls

Model Number: XTI-072X120-GARA046A

Serial Number: *CAXM XT0126

* If more than one piece of same equipment, list all serial numbers.

Location of equipment: S510 (5R)

Operator Controls

The types of controls available to the operator need to be determined. This should help identify energy sources and lockout capacity for the equipment.

List types of operator controls:

Circuit Breakers panel Variable Speed Drive (VFD) Supply Fan (SF) Exhaust fan (EF) Chilled Water valves (CHW) Medium Pressure Steam Valve (MPS) Low Pressure Clean Steam Valve (LPCS) Interior Light/receptacle

Energy Sources The energy sources, such as electrical, steam, hydraulic, pneumatic, natural gas, and stored energy, present on this equipment are:

Energy Source

Location

Lockable

Type Lock or Block

Needed

Electric Panel

EQPD-2 #17

East Wall near Mech Rm

S510 Door

Y

Circuit Breaker Type &

Padlock

VFD Disconnect

Mounted in front of Unit in

Center Aisle

Supply fan Disconnect

Mounted on North Wall of

Unit near Supply Fan Door

Chilled Water Supply &

Return #1013

Between units North Aisle overhead

Padlocks

Medium Pressure Steam

MPS #1010

Between units North Aisle overhead

Low Pressure Clean Steam

Near North Wall of unit

Shoulder height

Clamshell type

Shutdown Procedures

List the steps in order necessary to shut down and de-energize the equipment. Be specific.

For stored energy, be specific about how the energy will be dissipated or restrained.

Procedure:

Shutdown Unit from ECC Move Supply fan & Exhaust fan VFD disconnect to “OFF” position. Move Circuit Breaker to “OFF” position If applicable close Steam, Glycol Water & Chilled Water valves to closed position

Lock Type & Location:

Circuit Breaker, Clamshell or cable type locking devices, Locks & tags All Locks & Lock out devices located in the Energy Control Center NG15

How will the de-energized state be verified?

Clear all personnel from danger areas.

Check all isolated equipment is secured correctly before beginning task.

Verify main disconnect switches & circuit breakers cannot be moved to "ON" position.

Attempt to activate operating controls to ensure power is off.

Return all power switches & disconnects to “OFF” or “NEUTRAL” position.

If water or steam is being shut down, open drains to relieve pressure.

Notify All Affected Employees When This Procedure Is In Application!

Start Up Procedures List the steps in order necessary to reactivate (energize) the equipment. Be specific.

Procedure:

Clean up and Inspect work areas.

Remove locking devices from valves and close any drains that are open. SLOWLY open valves.

Remove all locking devices and close all Knife type disconnects.

Remove locking devices &/or locks from VFD's move to ON/START/RUN position.

Remove locking devices & locks from circuit breakers move switches to ON position.

Verify all personnel are removed from Danger areas.

Contact ECC to start up AHU.

Energy Source Activated:

Hot Water & Chilled Water valves Steam valves Electrical from Panel Knife switches for fans and interior lights/receptacles VFD's for Supply fan, Exhaust Fans

Notify All Affected Employees When This Procedure

Is in Application!

AHU107-1 ID Plate

AHU107-2 Breaker Panel EQPD-2 #17

AHU107-3 VFD Disconnect

AHU107-4 Supply Fan Disconnect

AHU107-5 Chilled Water Supply CHWS#1013

AHU107-6 Chilled Water Return CHWR#1013

AHU107-7 Medium Pressure Steam MPS#1010

AHU107-8 Low Pressure Clean Steam