Sample_eForm_493.xlsx
XLSX spreadsheet 118 KB Posted
- Attached to
- Lock Out Tag Out (LOTO) Federal contract opportunity
- Solicitation number
- FA8126-19-Q-A038
About this file
Sample eForm 493
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| WD.pdf | ||
| LOTO_PWS.pdf | ||
| LOTO_Combo.pdf | ||
| Serv_19-036_LOTO_-_Appendix_A_-_List_of_FEM_Assets_Requiring_eForm_493.xlsx | XLSX spreadsheet |
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Text version
Procedure PG1
| LOCKOUT-TAGOUT PROCEDURE | ||||
| OSHA 29 CFR 1910.147 | Developed By | Reviewed By | Revised By |
| Description: | Equipment #: | ||||
| Building: | Post Loc: | Area: | Revn: 0 | Date: N/A | Origin Date: |
# Isolation Points to be Locked and Tagged NOTE
| ALWAYS PERFORM A MACHINE STOP BEFORE LOCKING OUT DISCONNECTS | |||||
| ID | Source | Device | Location | Method | Check |
| ICON | Energy Source |
& Magnitude
| Warning Source | ICON | Warning Text |
| Warning Source | ICON | Warning Text |
| OPENING A GUARD DOES NOT CONSTITUTE A LOCKOUT |
| Procedures must be updated to account for any equipment modifications. |
| Safety Is Your Responsibility! |
OC-ALC Form 493 Equivalent Page &P of &N
Front View Back View Side View Picture Picture Picture
9 Step Process
LOCKOUT-TAGOUT PROCEDURE
OSHA 29 CFR 1910.147
Purpose: To protect authorized employees against unexpected or unplanned activation of equipment or energy while servicing equipment.
Scope: Utilize this procedure for all scheduled PM shutdowns or any maintenance task that requires you to place your body in harms way of the equipment.
Enforcement: Failure to properly follow lockout-tagout procedures may result in disciplinary action.
| # | STEP | DESCRIPTION |
| 1 | Preparation | Determine if equipment-specific written energy control procedures are applicable to the task. If so, the worker shall review control procedures and ensure they are followed correctly. |
| 2 | Notification | Notify all affected workers of the impending shutdown and that they shall not disturb lockout devices or attempt to re-start the equipment until informed it is safe to resume normal operations. |
| 3 | Shutdown | Verify it is safe to shut down the equipment or machine. The equipment or machine shall be turned off or shut down using normal stopping and shutdown procedures (depress stop button, open toggle switch, close shut off valve, etc.). |
| 4 | Isolation & Verification | Isolate all energy sources by operating (switch off, valve off, etc.) energy-isolating device(s). Verify the correct energy-isolating device has been operated and that steps taken to ensure energy isolation correctly correspond to the equipment that requires LOTO. Ensure all energy isolating devices needed to control the energy to or contained within the equipment or machine are used. |
| 5 | LOTO Device Application | Affix LOTO devices (typically locks) to hold energy-isolating devices in an off or safe position that physically prohibits normal operation of the energy-isolating device. Both tags and locks shall be installed. Tags shall indicate date, time, reason and name of the worker installing the device. |
| 6 | Additional Measures | Once the system is locked and tagged out, all potentially hazardous stored or residual energy shall be relieved, disconnected, restrained or otherwise rendered safe. Equipment or machines shall be in a zero energy state. |
| 7 | Isolation Confirmation | Physically attempt to operate energy-isolating devices and attempt to restart the equipment or machine using normal controls. Caution: Return operating controls to safe or off position after the test. |
| 8 | Keep LOTO Devices in Place | A lock and tag shall remain in place until work on the equipment or machine is complete. |
| 9 | Release From Lockout/Tagout Process | Ensure all personnel, tools and maintenance or servicing equipment have removed and guards have been reinstalled. Notify personnel the locks or tags have been removed and equipment is in service. Remove all locks or tags and restore the energy isolating device to the ‘ON’ position. |
| Preparation & Notification | Notify all affected workers the system is ready for return to service. Ensure all personnel are clear of the equipment point of operation and other hazard zones. Inspect the work area and ensure all tools, debris and non-essential personnel are removed or are a safe distance from the equipment or machinery. Replace safety guards, inspect equipment or machinery and ensure guards are operational. | |
| Removal of Additional Devices | Remove any additional devices applied IAW LOTO Application Step Six. Remove all safety grounding devices. Verify the work for which LOTO was applied is complete and it is safe to reenergize the equipment or machinery. | |
| Removal of all Locks & Tags | Authorized workers shall remove all LOTO devices and restore the energy isolating device to the ON position. Notify all workers the lockout condition has been cleared (locks and tags removed) and equipment or machinery is ready for service. Energize the equipment or machinery and restore to normal operating condition. Annotate LOTO log with clearance information. |
Reference: OSHA CFR 1910.147, Appendix A, "Typical minimal lockout procedures - 1910.147 App A"
OC-ALC Form 493 Equivalent Page &P of &N
Procedure Inspection Sheet
| LOCKOUT-TAGOUT PROCEDURE - INSPECTION SHEET | |||||||
| OSHA 29 CFR 1910.147 | OC#: | ||||||
| Inspection Date | Inspector | Observer | Acceptable | Requires Modification | Delete | Result Comments |
OC-ALC Form 493 Equivalent Page &P of &N
Info sheet Equipment Location EnergySource Location Method Device Check View Area / Shop Caution Warning
| Building: 200 | Electrical 120V | Isolation point on North side of . | Move E-1 disconnect to off. Lock out. | Universal Plug Device | Attempt restart at | |||||||||||
| CP-1. | North Side View | Area: | CAUTION | Thermal Energy Hazard: Wait for heat to dissipate from machine before servicing. Wear proper PPE before beginning work. | ||||||||||||
| Building: 210 | Electrical 240V | Isolation point on South side of . | Unplug E-1. Lock out. | Ball valve device | Attempt restart at all Control Panels. | South Side View | Area: Electric Shop | NOTE | Kinetic Energy Hazard: Wait until all moving parts have come to a complete stop. Utilize blocking device to prevent equipment from moving while servicing if necessary. | |||||||
| Building: 213 | Electrical 480V | Isolation point on East side of . | Move E- disconnect to off. | |||||||||||||
| Lock out. | Gate valve device | Verify zero voltage reading with meter. | East Side View | Area: Machine Shop | DANGER | Radiation Hazard: Equipment is capable of emitting hazardious levels of radiation. | ||||||||||
| Building: | Electrical 208V | Isolation point on West side of . | Turn W-1 valve to closed position. Lock out. | Cable device | Verify zero pressure status. | West Side View | Area: Millwright Shop | Pinch Hazard: Equipment presents a serious pinch hazard during maintenance. Take appropriate precautions. | ||||||||
| Building: | Electrical 277V | Isolation point located on MCC panel # . | Turn P-1 valve to closed position. Lock out. | Breaker lockout device | Verify machine is deenergized. | Northeast View | Area: Motor Shop | Caution Note | Corrosive Hazard: Equipment contains corrosive elements. Take appropriate precautions. | |||||||
| Building: | Electrical 550V | Disconnect P-1 fitting. Lock out. | Quick disconnect device | Northwest View | Area: Paint Shop | Potential Energy Hazard: Equipment presents a serious potential energy (gravity) hazard. Be sure to lower all parts to lowest position or install blocks before attempting to service machine. | ||||||||||
| Building: | Electrical 575V | Turn xxx-999 valve to closed position. Lock out. | Padlock | Southeast View | Area: Pipe Shop | Pressurized refrigeration loop to be serviced by authorized personnel only. | Hydraulic Hazard: Hydraulic equipment can store energy. Ensure all pressures have bled off before proceeding. | |||||||||
| Building: | Chemical XXX | Disconnect xxx-999 fitting. Lock out. | Southwest View | Area: PM Shop | Crane is suspended overhead. Unload and secure crane before proceeding. | Solvent chemical hazard. Wear proper PPE. Ensure ventilation is adequate and all chemicals are accounted for before proceeding. | ||||||||||
| Building: | Pneumatic XXX PSI | Reference Tag # on machine for proper electrical disconnect. | Front Side View | Area: Sheet Metal | Sharp blades. Take precautions and wear proper PPE when servicing. | |||||||||||
| Gas Freon | Back Side View | Area: Welding Shop | Control air is not considered part of this procedure. You must disconnect air before servicing air controlled components. | |||||||||||||
| Gas Natural Gas | Area: Wood Shop | Service to the automated valves is not considered part of this procedure. You must disconnect air before servicing valve. | ||||||||||||||
| Gas Nitrogen | Area: | |||||||||||||||
| Gas Oxygen | Area: | |||||||||||||||
| Gas Hydrogen | ||||||||||||||||
| Hydraulic Supply | ||||||||||||||||
| Hydraulic Return | ||||||||||||||||
| Oil Supply | ||||||||||||||||
| Steam |
Inlet Steam Outlet Valve Inlet Chilled Water Inlet Chilled Water Outlet Water Suction Water Discharge Kinetic Energy
XXXXX
Potential Energy Gravity
| Thermal Energy |
| Hydraulic Energy |
Page &P of &N &F
CP-1
CP-2
CP-3
CP-4
CP-5
CP-6
CP-7
CP-8
CP-9
CP-10
CP-11
Note: This is a generic procedure. Actual pictures and location of disconnects may vary by machine.
Caution:
LOCKOUT TAGOUT PROCEDURE
OSHA 29 CFR 1910.147
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