| Location | |
|---|---|
| Equipment | |
| Date | |
| Authorized Person |
| Step | Yes | No | Comments |
|---|---|---|---|
| Notify affected employees | |||
| Identify all energy sources | |||
| Shut down equipment | |||
| Isolate all energy sources | |||
| Apply lockout/tagout devices | |||
| Release or restrain stored energy | |||
| Verify isolation of equipment | |||
| Perform maintenance or servicing | |||
| Remove tools/equipment, reinstall guards | |||
| Remove lockout/tagout devices | |||
| Notify affected employees of restart |