Template For Specific Lockout Tag Instructions For Equipment Page 2
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3Template for specific Lockout tag instructions for equipment continued – (Page 2 of 2)
I.
Energy Checklists- circle that which applies
Energy Type
Hazard
Magnitude
Control Method
Electrical
Shock
110 VAC
Main Switch
Burn
220 VAC
Plug Control
Fire
208 VAC/30
Fuse Blocks
___________
___V____A
Shielding
Pneumatic
Mechanical/
Moderate
Air Line Valve
Pinch Points
Slight
Gas Cylinder Valve
Crush
High
Gas Line Valve
Laceration
___lb Force
___________
Flying Debris
Chemical
Flammable
Slight
Cylinder Valve
(Gas)
Corrosive
Moderate
Gas Line Valve
Toxic
High
Reactive
Chemical
Flammable
Slight
Valve
(Liquid)
Corrosive
Moderate
Flange Plate
Toxic
High
Reactive
Mechanical
Shaft in Motion
Slight
Main Electrical
Moving Parts
Moderate
Switch
Crushing
High
Plug Control
Laceration
____ft-lb
Shielding
Impalement
____hp
Blocking
Anti-Motion Pin
UV
Skin and Eye
Slight
Shielding
Burns
Moderate
Main Switch
High
Plug Control
___W/cm²@___%
Circuit Breaker
Electro Magnet
Strong Field
Slight
Main Switch
Moderate
Plug Control
High
Circuit Breaker
____Gauss
Thermal
Burns
Moderate
Main Switch
Temperature
Plug Control
High
Steam Valve
Temperature
Fluid Line Valve
Cryogenic
____°C
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Parent category: Business