S02 SF-09 Lock out tag out.pdf

LOCKOUT/TAGOUT PROGRAM

MCP SF-09-20

Coatesville VA Medical Center Coatesville, PA 19320

Signatory Authority:

Coatesville VA Medical Center Director

Responsible Owner:

Facilities Engineering Service (FES)

Rescinded Document:

MCP SF-09-18, Lockout/Tagout

Program

Effective Date:

January 2021

Recertification Date:

April 2023

1. POLICY

This medical center policy SF-09 establishes a policy to protect life, property and equipment from the unexpected energizing, startup of machines or equipment, or from the release of stored energy during the servicing or maintenance of machines or equipment.

2. JUSTIFICATION

This Facilities Engineering Service's (FES) policy listed in the OSHA Policy 29 CFR 1910.147, Control of Hazardous Energy establishes minimum requirements for the lockout or tag out of energy isolating devices.

3. RESPONSIBILITIES

a. FES Section. The FES Section is responsible for:

(1) Developing written Standard Operating Procedures for isolating energy sources for all machines or equipment on which their employees would be working, performing service or maintenance. Specific procedures need not be documented (i.e., in writing) if the machine or piece of equipment meets all eight elements listed under the exception in Section1910.147 (c)(4)(I) of the OSHA Lockout/Tag out Standard. Contact the Safety Office with any questions.

(2) Identifying authorized employees to perform servicing or maintenance on machines or equipment when lockout or tag out is required.

(3) Providing training with assistance from the Safety Office as outlined in this policy to all authorized employees. Training shall be documented and maintained to include date of training and names of employees.

(4) Ensuring that an annual review is conducted for lockout/tag out procedures that were developed for each machine or piece of equipment in the

January 1, 2021 MCP SF-09 lockout/tagout program. Documentation of the review will consist of changing the date on each procedure as well as a documented training session with the employees on the procedures. Supervisors will work with other services and the Safety Office to assure that all affected employees are included in the annual review.

b. Authorized Employees. The Authorized Employees are responsible for implementing the procedures in accordance with this policy and isolating energy sources for machines or equipment prior to any service or maintenance.

Disciplinary action may result if these procedures are not followed.

c. Safety Office. The Safety Office is responsible for coordinating and assisting Supervisors in providing training for the lockout and tagout program.

4. PROCEDURE

a. Lockout and tag out procedures shall only be performed by authorized personnel.

Personnel in the area not directly affected by the operation or shutdown of the machine or equipment shall be notified by the supervisor of lockout or tagout devices. Notification shall be given before the controls are applied and after they are removed from the machine or equipment. The established procedure for the application of locks or tags shall cover the following elements and be performed in the following order.

(1) Before a supervisor or the operator turns off a machine or equipment, they shall have knowledge of the type and magnitude of the energy source, the hazards of the energy source to be controlled, and the method or means to control the energy source.

(2) The machine or equipment shall be turned off or shutdown using the normal stopping and shutdown procedures (depress stop button, open toggle switch, close shutoff valve, etc.). A machine or other equipment using a simple wall plug as the power source will be unplugged, tagged, and controlled by the supervisor or operator.

(3) All energy isolating devices that are needed to control the energy to the machine or equipment shall be utilized.

(a) The initial lockout or tagout device shall be attached to each energy isolating device by the authorized personnel. Any additional qualified personnel who perform maintenance on the machine or equipment may apply their lock during the performance of their maintenance activity.

(b) Lockout or tagout devices, where used, shall be attached in a manner that will hold the energy isolating devices in a "safe" or "off' position.

(c) Tagout devices used with energy isolating devices designed with the capability of being locked shall be attached at the same point as the lock. In these cases where energy isolating devices cannot be locked because of design, tagout devices shall be attached. The tag will be secured with a self-locking and non-releasable attachment that has a minimum unlocking strength of no less than 50 pounds. An example is a nylon or plastic cable tie-off strap. These devices shall be attached in such a manner as to interfere with the operation of energy isolating devices.

(d) Where a tag cannot be attached directly to the energy isolating device, the tag shall be located as close and as safely possible to the device in a position that will immediately be obvious to anyone attempting to operate the device.

NOTE: Whenever major replacement, repair, renovation, and or modification of machines or equipment is performed, and whenever new machines or equipment are installed, energy isolating devices for such machines or equipment shall be designed to accept a lockout device.

(e) Prior to starting work on machinery or equipment that has been locked out or tagged out, the authorized employee shall verify that the machine or equipment has been deenergized or isolated. If there is a possibility of accumulation of stored energy to a hazardous level, verification of isolation shall be continued until the servicing or maintenance is completed, or until the possibility of such accumulation no longer exists.

(f) Before restoring machines and equipment to service, the supervisor or authorized employee will:

(i) Ensure all personnel, tools, and maintenance or servicing equipment have been removed and guards have been reinstalled.

(ii) Notify personnel the locks or tags have been removed and equipment is in service.

(iii) Remove all locks or tags and restore the energy isolating device to the "ON" position.

(g) Whenever it becomes necessary to remove lockout or tagout devices to temporarily startup machines or equipment for testing or component repositioning, restoration procedures shall be performed according to instructions in paragraphs 4.0 A.

(h) Immediately upon completion of the testing or repositioning procedures, the affected machines or equipment shall be locked or tagged out according to instructions in paragraphs 4.0 A.

(i) Specific procedures shall be utilized during shift or personnel changes to ensure the continuity of lockout or tagout protection. This includes a provision for the orderly transfer of these devices between off-going and on-coming supervisors This will minimize exposure to hazards from the unexpected energization, start-up, or release of stored energy from machines or equipment. On-coming supervisors and employees shall be required to "lock-on" before the off- going supervisor/employees will "lock-off." When the machine or equipment is out of service for an extended period, there is no requirement to transfer the supervisor locks and tags during each shift change.

(j) Authorization for removal of an abandon lock is required by the Chief of Facilities Engineering Services. Removal of an abandon lock without such approval is prohibited and punishable.

(k) Whenever a group lockout/tagout (Gang Lockbox) procedure is utilized, a supervisor will be responsible for the group lockout.

b. TRAINING:

(1) Training shall be provided to ensure the purpose and function of the lockout and tagout programs are understood by the authorized employee and qualified equipment maintenance personnel. It will ensure that the knowledge and skills required for safe usage of lockout and tagout procedures in paragraph 4.0 A. are understood. The training shall include the following:

(a) Initial job training on the type and magnitude of applicable energy sources, the methods and means necessary for energy isolation and control, and the use of the lockout and tagout procedures will be provided to each authorized personnel or any qualified equipment maintenance person.

(b) All other personnel, whose duties are or may be in an area where lockout and tagout procedures may be utilized, shall be briefed on the program during the initial job safety briefing. See Attachment A.

(2) When lockout or tagout procedures are used, the authorized personnel or any qualified equipment maintenance personnel shall receive initial job training on the following use of locks and tags (See Attachments B and C):

(a) Tags are essentially warning devices attached to energy isolating devices, and do not provide the physical restraint on those devices that is provided by a lock.

(b) When a lock or tag is attached to an energy isolating device, only the supervisor and the authorized personnel who initially installed the lock or tag can remove it. It can never be bypassed, ignored, or otherwise defeated.

(c) Tags may cause a false sense of security, and their use and limitations need to be understood as part of the overall energy control program.

(d) Tags will be securely attached, so they cannot be inadvertently or accidentally detached during use.

(3) Retraining shall be provided for the authorized employee, supervisors, and qualified equipment maintenance personnel whenever there is a change in their job assignments, a change in machines or equipment, processes that present new hazard, or when there is a change in the lockout or tagout procedures. Additional retraining shall be conducted whenever a periodic inspection reveals there are deviations from, or inadequacies in, the supervisor, operator, or qualified equipment maintenance personnel's knowledge or use of the lockout or tagout procedures.

(4) All training shall be documented in accordance with Medical Center Policy (MCP) SF-03, Safety Education Program. Training shall be certified, documented, and kept up to date. The certification shall contain each individual's name and date(s) of training.

c. INSPECTIONS:

(1) Inspections of the lockout and tagout programs shall be conducted at least annually by a qualified safety office to ensure compliance. The inspection shall include as a minimum, the program procedures, training and documentation.

(2) Annual self-inspection (Attachment D) shall be conducted by the Facilities Engineering Supervisors to ensure compliance with all program elements.

The self-inspection shall include as a minimum, the identification of the machines and equipment on which the lockout and tagout program is used, a review of each person's responsibilities under the program, and that all necessary training has been conducted and documented. The self-inspection shall be documented to include the date of the inspection and the unit representative conducting the self-inspection.

(3) Lockout/tagout devices shall indicate the identity of the employees applying the device and shall warn against the hazardous conditions if the equipment is energized.

(4) Supervisors will train all affected employees and will ensure that the purpose of this program is understood by all employees, and they are thoroughly familiar with the application, usage and removal of energy control devices.

5. ATTACHMENTS:

a. Attachment A - Preparation for Lockout/Tagout

b. Attachment B - Steps for Lockout/Tagout

c. Attachment C - Single and Multi-sources

d. Attachment D - Employee Annual Evaluation Form

6. DEFINITIONS

a. Abandon Lock. Abandon Locks are locks that are abandoned by an employee after a shift. Removal of an abandon lock can only be authorized by the Chief of Facilities, Engineering Services.

b. Gang box or Device. Gang boxes are used when multiple locks for equipment contain more than one source (steam, electrical, gas, etc.). Locks are applied to each source according to a LO/TO procedure for the equipment with same core locks. The key is placed in a centrally located Gang Box with an attached hasp or clasp for multiple employee locks. Only when the hasp/clasp is free of employee locks can the Gang Box key be accessed.

c. Lockout and Isolation Devices. Lockout devices are a positive means to isolate energy and prevent the unexpected start-up of machines and equipment. Energy sources shall be locked out prior to the start of inspection, maintenance, or servicing actions which require the removal of guards and will remain locked out until all activities are complete. Common lockout devices are clasp, hasp, gang boxes and employee locks. All employee locks dedicated to the lockout program are unique to the employee with the employee's initials or name etched into the lock. Employee locks can only be unlocked by the employee using the lock.

d. Supervisor Locks. Supervisory or Lead locks are issued to the supervisor or lead personnel with the authority to lock out equipment for long term repair or maintenance. Supervisory locks do not require removal after each shift.

e. Tags. Tags are a temporary means of warning all concerned of a hazardous condition, defective equipment, etc. Tags are not to be considered as a complete warning method but should only be used until a positive means can be employed to eliminate the hazard. For example, a "Do Not Start" tag affixed to a machine is only a temporary warning that shall be used until the machine can be locked out, de-energized, or inactivated (29 CFR 1910.147). No servicing or maintenance will be performed until an approved lockout device is installed.

a. REFERENCES OSHA Standard 29 CFR 1910.147

b. OSHA Standard 29 CFR 1926.417

c. OSHA Standard 29 CFR 1910.331-.335 SOP

7. RESCISSION

MCP SF-09-18, Lockout/Tagout Program, is rescinded.

8. REVIEW

This Medical Center Policy SF-09-20 is to be recertified every five years at a minimum.

9. RECERTIFICATION

This MCP is scheduled for recertification on or before the last working day of April 2023. This MCP will continue to serve as local policy until it is recertified or rescinded. In the event of contradiction with national policy, the national policy supersedes and controls.

10. SIGNATORY AUTHORITY

Jeffery A Beiler II VA Medical Facility Director

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Medical Center Policies are available here. Medical Center Policy Attachments are available here.

https://dvagov.sharepoint.com/sites/VHACOAvamc/policies/default.aspx https://dvagov.sharepoint.com/sites/VHACOAvamc/policies/MCP%20Attachments/Forms/AllItems.aspx

ATTACHMENT A - Preparation for Lockout/Tagout

1. PREPARATION FOR LOCKOUT/TAGOUT:

a. Notify all affected employees of the application and removal of the lockout/tagout device, before the controls are applied and after they are removed.

b. Review the equipment specific lockout/tagout SOP. Then survey the machine to locate and identify all isolating devices to ensure that the switch, valve or other device applies to the equipment are being isolated, and that there is not more than one energy source involved.

c. If the machine is operating, shut it down using the normal stopping procedure.

d. Operate the energy isolating device (i.e., close valve, shut off electrical power, etc.), so that the equipment is isolated from its energy source. Stored energy such as in springs, elevated machine members, rotating flywheels, hydraulic systems, air, gas, steam, water pressure, etc. must be dissipated by methods such as repositioning, blocking bleeding, etc.

e. Lock or tagout the energy isolating device with an assigned individual lock or tag.

f. After ensuring that no personnel are exposed and a check on having disconnected the energy sources, operate the normal starting procedure to make certain the equipment will not operate. Return the operating control to the off position.

g. The equipment is now locked out or tagged out.

2. RESTORING THE EQUIPMENT TO NORMAL OPERATION:

a. After servicing is complete, check the area around the machine to ensure that no one is exposed.

b. After all tools have been removed from the machine or equipment; guards have been reinstalled and employees are clear, remove the lockout/tag out device.

Restore energy to the machine or equipment by operating the energy isolating device.

c. Only the employee who applied the device may remove a lockout/tagout device. In extraordinary circumstances, the supervisor may remove the lock or tag.

3. PROCEDURES INVOLVING MORE THAN ONE PERSON:

a. Each individual shall place his or her lockout/tag out device to the energy isolating device.

b. A multiple lockout/tagout device will be utilized if the energy isolating device cannot accept multiple locks.

4. BASIC RULE:

a. All equipment that could cause injury shall be locked or tagged out to protect against accidental or inadvertent operation during any maintenance or repair activity.

b. Never attempt to operate any switch, valve or other energy isolating device where it is locked or tagged out.

ATTACHMENT B – Steps for Lockout/Tagout

Follow these steps for a typical lockout before all maintenance and repair work:

Step 1: Alert the operator and floor supervisor that you are ready.

Step 2: Identify all sources of residual energy on the machinery.

WARNING

Before beginning work, perform these procedures in the following order:

Step 3: Place padlocks on the switch, lever, or valve to lock the equipment in the OFF position. Put tags at this location to indicate that maintenance is in progress.

Step 4: "Bleed" all hydraulic or pneumatic pressure and all electrical current (capacitance) so that machine components will not accidentally move.

Step 5: Verify that all energy is disconnected by testing the operator controls.

Step 6: When this is complete, replace all machine safeguards that were removed.

Secure and check them to make sure they fit properly.

Step 7: Finally, remove padlocks and clear the machine for operation.

ATTACHMENT C – Single and Multi-Sources

Source Equipment Magnitude of Energy

Shop Service

Single Steam Kettle Steam – Scalding 15

PSI

General Utilities FES

Single Condensing Unit/Walk-in Refrigeration

Electrical – Electrocution 208 volts

General Utilities FES

Single Band Saw, Air Compressor, Horizontal Band Saw, Welding Machine

Electrical — Electrocution 120/208 volts

Fac Site Service FES

Single Carpentry Shop: Band Saw, Planer, Jointer, Table Saw, Radial Saw, Sander

Electrical — Electrocution 120/208 volts

General Properties

FES

Single Air Compressor Electrical — Electrocution 120/208 volts, Air — High Pressure 150

PSI

General

Properties/Utilities

FES

Single Retherm Units Electrical — Electrocution 208 volts

General

Properties/Utilities

FES

Single Air Handling Units Electrical — Electrocution 208 volts

General Utilities FES

Single Split Systems Electrical — Electrocution 120/208 volts / Disconnect

General Utilities FES

Single Exhaust Systems/Building

Electrical — Electrocution 120/208/480 volts

General Utilities FES

Single Sewage Ejection System

Electrical — Electrocution 120/208 volts

General Properties/Utilities

FES

Single Can Crusher Electrical — Electrocution 120/208 volts

General Properties

FES

Single Cadaver Box (B10/1) Electrical — Electrocution 120 volts

General Utilities FES

Multi Chiller Plant and Pumps

Electrical - Electrocution 120/208/480/4160 volts, Water - High Pressure 40-80 PSI

General Utilities FES

Multi Hot Water Pumps Electrical - Electrocution 208 volts, Water - High Pressure 40 PSI, Temp. 70-180 degrees Fahrenheit

General Utilities FES

Multi Gas Water Pumps Gas - Explosion 3-5

PSI

General Utilities FES

Multi Electric Domestic Hot Water Heater

Electrical - Electrocution 120/208 volts, Water Pressure - 50 PSI, Water Temperature - 120 degrees F.

General Properties/Utilities

FES

Multi Steam Driven Domestic Water Hot Water

Steam - Burns 50 PSI, Water Temperature - 120 degrees

General Utilities FES

Multi Energy Recovery Pumps

Electrical - Electrocution 208 volts

Multi Condensate Pumps Electrical - Electrocution 208 volts, Steam - Scalding 50 PSI, Condensate - Scalding 170 degrees

General Properties/Utilities

FES

Multi Pool Filter Pumps (Bldg 58/Outdoor Pool)

Electrical - Electrocution 120/208 volts, Water

- 30 PSI

General Properties/Utilities

FES

Multi Chilled Walter Pumps Electrical - Electrocution 208 volts, Water - 80 PSI

General Utilities FES

Multi Elevators Electrical - Electrocution 208/480 volts, Hydraulics - 100 PSI

General Properties

FES

Multi Sterilizers Steam - Burns 50 PSI, Electrical - Shock 120/208 volts

General Properties/Utilities

FES

Multi Cage Washers Steam - Scalding 50 PSI, Water - High 50 PSI, Electrical - Electrocution 208 volts

General Properties/Utilities

FES

Multi Vacuum Pumps Electrical - Electrocution 208 volts, Vacuum - Infectious

General Properties

FES

Multi Emergency Generators

Electrical - Electrocution 120/208/277/480 volts, Fuel - Fire Hazard

General Properties

FES

Multi Dish Machine / Pot Machine

Electrical - Electrocution 120/208/480 volts, Steam - Burns 170 degrees

General Properties/Utilities

FES

Multi Gas Unit Heaters Asphyxiation - Propane, Electrical - Electrocution 120 volts

General Utilities FES

Multi Boiler Plant & Transfer Pumps

Steam - Burns 340 degrees, Water Temp - 220 degrees, Electric - Shock 120/208/480 volts, Oil - Burns

ATTACHMENT D - Employee Annual Evaluation Form

Required Frequency: Annually

To meet OSHA requirements at least one person who performs the Hazardous Energy

Control Assessment must be on the location's list of authorized employees.

LOCK-OUT/TAG-OUT PERIODIC REVIEW FORM

This form shall be used to verify that a lockout/tagout procedure is correct and current.

The review shall certify that the procedure is utilized properly and shall be performed at least annually.

Employee Name: Date:

Equipment Location:

Check all energy sources which were locked and tagged out:

1. Electrical 2. Pneumatic 3. Hydraulic

4. Thermal 5. Mechanical 6. Chemical

7. Other

Were all energy sources de-energized according to the machine specific procedure?

Yes No

Are the written procedures adequate in controlling all energy sources?

Yes No

Were the results of this review covered with the employee(s)?

Yes No

List steps taken to correct deviations or deficiencies with this procedure:

Reviewing Employee

This form shall be returned to the Safety and Occupational Health Manager (QI) upon completion of the review. This form will remain on file for one (1) year.