HAZARDOUS ENERGY CONTROL (LOCKOUT / TAGOUT) PROGRAM
UNIVERSITY OF WASHINGTON – DEPARTMENT SPECIFIC PROGRAM
Department: School of
Location:
Date Prepared:
,
Shop
TABLE OF CONTENTS
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
Purpose
Scope
Responsibility
Basic Lockout Principles
Training
Lockout Procedures
Program Inspection and Review
Outside Contractors
ATTACHMENTS
1.
2.
3.
4.
5.
6.
7.
I.
Training Record
Lockout Equipment Listing
Lockout Program Inspection
Annual Lockout/Tagout Administrative Review
Lockout/Tagout Schedule
Authorized Employee Training Certificate
Authorized Employee Annual Certification
PURPOSE
The purpose of this program is to protect employees of the University of Washington
School of
Shop from injuries while servicing and maintaining equipment.
II.
SCOPE
The program establishes requirements for hazardous energy control. It is to be used to
ensure that machines and equipment are isolated from all potentially hazardous energy
sources whenever servicing or maintenance activities are in progress.
III.
RESPONSIBILITY
1.
, Shop Manager, is designated as the Program Coordinator for this Shop.
Specific responsibilities include:
a. Provide Hazardous Energy Control training to employees.
b. Maintain a current listing of employees who have completed lockout training.
c. Maintain a current list of all equipment/machines that fall under the
Hazardous Energy Control program. Listing is to be updated each time a
change occurs.
d. Implement and enforce this program.
Revised February 2015
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e. Maintain an adequate supply of padlocks and DANGER tags for use each
time a lockout process is performed. Padlocks are located (location where
locks are stored).
f. Conduct the annual inspection and review as required by section VII.
2. Each supervisor is responsible for the effective use of this program in the work group
and to see that all required procedures are followed in every instance.
3. Each employee is responsible for learning and following the procedures and
practices developed under this program. Notify the Program Coordinator prior to a
lockout process.
IV.
V.
BASIC LOCKOUT PRINCIPLES

All equipment must be locked out to protect against accidental or inadvertent
operation, when operation could cause injury to personnel. Locks are to be
applied and removed only by the authorized employee who is performing the
servicing or maintenance.

No one should attempt to operate locked-out equipment.

Disciplinary action will be applied if any employee violates these procedures,
regardless of whether or not physical harm or equipment damage results.

Lockout devices (padlocks) with an appropriate DANGER warning tag shall be
used only for energy control. Prior to the servicing or maintenance of equipment
a padlock and DANGER warning tag will be obtained from the Program
Coordinator. Each padlock will be keyed differently with no master key or
duplicate keys available.
TRAINING
Each authorized employee will be trained in the recognition of applicable hazardous
energy sources, the type and magnitude of the energy available in the workplace, and
the methods and means necessary for energy isolation and control.
Each affected employee shall be instructed in the purpose and use of the energy
control procedure.

Affected employee. An employee whose job requires him/her to operate or use
a machine or equipment on which servicing or maintenance is being performed
under lockout or tagout, or whose job requires him/her to work in an area in
which such servicing or maintenance is being performed.

Authorized employee. A person who locks out or tags out machines or
equipment in order to perform servicing or maintenance on that machine or
equipment. An affected employee becomes an authorized employee when that
employee’s duties include performing servicing or maintenance covered under
the standard.
Revised February 2015
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All other employees who do not work in areas where lockout may be used will be
provided a brief overview of the lockout program.
Training in lockout will be given to all new employees as a part of their orientation.
Retraining will be conducted whenever there is a change in job assignment, a change in
machinery or equipment or process change that presents a new hazard.
Training records will be kept for all employees covered under the standard.
VI.
LOCKOUT PROCEDURES
A. SEQUENCE OF LOCKOUT:
The following are specific procedures to be followed for lockout.
1. Notify the Program Coordinator
, Shop Manager, Phone:
.
2. Notify all affected employees that lockout is going to be utilized, and the
reason why.
3. If the machine/equipment is in operation, shut it down by the normal
shutdown procedure.
4. Operate the appropriate switch, valve, etc., so that the machine/equipment is
isolated from the energy source.
5. Lock the energy isolating devices, using assigned locks and danger tags.
6. Release, restrain, or dissipate any stored energy.
7. Verify that energy isolation is complete, by attempting to start the affected
machinery or equipment in the normal manner.
8. After testing, return all operation controls to the "neutral" or "off" positions.
B. RESTORATION TO NORMAL:
1. After service or maintenance is complete, check the area to ensure that no
employees are exposed.
2. Remove all tools and repair equipment.
3. Ensure that all guards have been replaced and all safety interlocks
reactivated (if so equipped).
4. Verify that the operating controls are in the "off" or neutral position.
5. Remove all lockout and tag devices and activate the energy isolation devices
to restore energy.
VII.
PROGRAM INSPECTION AND REVIEW
At least annually, the Program Coordinator will verify the effectiveness of the energy
control procedures. These inspections shall provide for a demonstration of the
procedures and may be carried out through random audits and observations.
The inspector will review the Hazardous Energy Control Procedure with all authorized
employees and actually observe the use of the procedure. This inspection will be
certified and documented by the inspector using a Hazardous Energy Control Lockout
Procedure Inspection Review Form (Appendix B).
These inspections are to ensure that the energy control procedures are being properly
used and to provide a check on the continued adherence to the procedures. (Name of
Revised February 2015
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person or title) will certify that the prescribed inspections have been performed. Any
deficiencies will be corrected immediately, either by modification of the procedure,
retraining of employees, or a combination of both.
Annual Lockout/Tagout Program Review Form (Appendix C).
VIII.
OUTSIDE CONTRACTORS
Outside personnel or contractors involved in lockout of equipment or machinery that
affects our employees must submit their energy control procedures, in writing, to the
Program Coordinator. All affected employees must be trained in and familiar with the
contractor's submitted procedure.
In order to protect our employees, the contractor's work area will be isolated, and access
by our employees will be restricted. If this is impractical or cannot be accomplished, the
Program Coordinator must assure the contractor's compliance with proper work
procedures, energy isolation procedures and contractor employee compliance.
Contractors failing to adhere to the provisions of the OSHA Hazardous Energy Control
standard will be asked to terminate their work until their program is brought into
compliance.
Revised February 2015
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Appendix A:
Inventory of Equipment for Lockout/Tagout
Equipment
Name
Revised February 2015
Energy
Sources
Control
Mechanisms
Energy
Isolating
Devices
Questions? Contact ehsdept@uw.edu
Appendix B:
Equipment Specific Energy Control Procedures
Revised February 2015
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Sample Lockout Procedure
Instructions
Use with Lockout/Tagout (Control of Hazardous Energy), Chapter 296-803 WAC
 The following sample lockout procedure contains the minimum
information necessary to help you develop an energy control procedure
that meets the requirements of Lockout/Tagout (Control of Hazardous
Energy), Chapter 296-803 WAC.
 Complex systems may require you to develop, document, and use more
comprehensive procedures.
 You can use this fill-in-the-blank template, or develop your own form.
Note:
If you develop your own form, remember to include the necessary
information from this template.
Revised February 2015
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Fill-in-the-Blank Template
SCOPE:
This lockout procedure is for:
Department Name if you only use a single procedure (one machine or type of machine)
Or
Specific machine or equipment that this procedure applies to, if you use multiple procedures. For
additional information, see WAC 296-803-20005)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
PURPOSE:
 This procedure establishes the minimum requirements necessary to protect
employees from injury caused by the unexpected energization, start up, or release of
stored energy during service or maintenance.

Use this procedure to make sure the machine or equipment is stopped, isolated from
all potentially hazardous energy sources, and locked out before any employee
begins work.
AUTHORIZATION:
 The following persons are authorized to lock out the machine or equipment using
this procedure:
(List the names of authorized employees you want to use this procedure)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
COMPLIANCE WITH THIS PROGRAM:
 All employees are required to comply with the restrictions and limitations imposed
upon them during the use of lockout.
 Authorized employees will perform lockout as described in this procedure.
 No employee will attempt to start, energize or use any machine or equipment that is
locked out.
 Failure to comply with this procedure will result in the following action:
(List the actions that will be taken if employees violate the procedure)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Revised February 2015
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INTENDED USE:
 This procedure will be used for the following service or maintenance actions:
(List the service and maintenance activities that require using the procedure)
____________________________________________________________
____________________________________________________________
____________________________________________________________
SPECIFIC PROCEDURAL STEPS:
Step 1:
The authorized employee will identify the type and magnitude of the
energy that the machine or equipment uses, understand the hazards of
the energy, and the methods to control the energy before using this
procedure.
(List the type and magnitude of the energy, its hazards, and the methods to control the energy. For
additional information, see WAC 296-803-50010)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Step 2:
Notify all affected employees that the machine or equipment is to be shut
down and locked out for service or maintenance.
(List the names or job titles of affected employees and how to notify them. For additional information, see
WAC 296-803-50010)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Step 3:
Shut down the machine or equipment by the normal stopping procedure
(such as depressing a stop button, opening switches, or closing valves).
(List types and locations of machine or equipment operating controls. For additional information, see
WAC 296-803-50010)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Step 4:
Completely isolate the machine or equipment from its energy sources by
using the appropriate energy-isolating devices.
(List types and locations of energy isolating devices. For additional information, see WAC 296-80350010)
____________________________________________________________
____________________________________________________________
SPECIFIC PROCEDURAL STEPS: (continued)
Revised February 2015
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Step 5:
Lock out the energy isolating devices with assigned individual locks.
(List any additional procedural requirements, such as putting on a tag with amplifying information,
necessary for the authorized employee to know. For additional information, see WAC 296-803-50010)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Step 6:
Dissipate or restrain stored and residual energy, such as that in
capacitors, springs, elevated machine members, rotating flywheels,
hydraulic systems, and air, gas, steam, or water pressure, using methods
such as grounding, repositioning, blocking, or bleeding down.
(List the types of stored and residual energy and the methods to dissipate or restrain them. For additional
information, see WAC 296-803-50025)
____________________________________________________________
____________________________________________________________
____________________________________________________________
(List any actions necessary to prevent stored energy from accumulating to a hazardous level. For
additional information, see WAC 296-803-50025)
____________________________________________________________
____________________________________________________________
____________________________________________________________
Step 7:
Make sure the equipment is disconnected from the energy sources and
stored and residual energy has been made safe. Check that no personnel
are exposed, then verify the isolation of the equipment by doing the
following:
(List the method of verifying machine or equipment isolation, such as operating the push button or other
normal operating controls or by testing to make certain the equipment will not operate. For additional
information, see WAC 296-803-5003)
____________________________________________________________
____________________________________________________________
____________________________________________________________
CAUTION: Return the operating controls to the safe, neutral, or off position, after
verifying the equipment is isolated from its energy sources.
THE MACHINE OR EQUIPMENT IS NOW LOCKED OUT
Revised February 2015
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
Restore the machine or equipment to service after the service or maintenance is
completed and the machine or equipment is ready to return to its normal operating
condition by doing the following steps:
(For additional information, see WAC 296-803-50035)
Step 1:
Check the machine or equipment and the immediate area around it to
make sure all nonessential items have been removed and that the
machine or equipment is in operating condition and ready to energize.
Step 2:
Make sure all employees are safely positioned for starting or energizing
the machine or equipment.
Step 3:
Verify that the controls are in neutral.
Step 4:
Remove the lockout devices and reenergize the machine or equipment.
Note:
Some forms of blocking may require re-energization of the machine
before they can be safely removed.
Step 5:
Notify affected employees that the servicing or maintenance is completed
and the machine or equipment is ready to use.
Revised February 2015
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Appendix C:
Lockout/Tagout Inspection Procedure Review Form
Note to employers: Use this form to document an inspection of a written lockout or tagout procedure.
Department:
Equipment type and serial number:
Inspection conducted by:
Equipment location:
Inspection date:
Revised February 2015
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List authorized employees using this procedure. Has the employee been trained in the procedure?
Employee name:
Yes
No
Employee name:
Yes
No
Employee name:
Yes
No
Employee name:
Yes
No
Do authorized employees know the location of the written procedure?
Yes
No
Do authorized employees have access to the procedure?
Yes
No
Are affected employees notified when the procedure is being used?
Yes
No
Have affected employees been trained to recognize when the procedure is being used and instructed
not to remove lockout/tagout devices or start de-energized equipment?
Yes
No
Can energy-isolating devices be locked out?
Yes
No
Did each authorized employee lock out all energy sources?
Yes
No
Does this procedure involve group lockout/tagout?
Yes
No
Did the authorized employees verify that the equipment was de-energized?
Yes
No
Did the authorized employees follow the lockout/tagout procedure?
Yes
No
Does the lockout/tagout procedure adequately protect employees?
Yes
No
Yes
No
Note: When you replace, renovate, or modify machines and equipment, ensure that the energy-isolating
devices will accept lockout devices. New equipment and equipment renovated or modified after January
2, 1990, must be capable of being locked out.
If not, list and describe the deficiencies requiring corrective action.
1.
2.
3.
4.
5.
If this is a lockout procedure, did the inspector review with all authorized and employees their
responsibilities under the procedure? Note: A review can be accomplished by meeting with employees
individually or in a group.
Not applicable
If this is a tagout procedure, did the inspector review with all authorized and affected employees their
responsibilities under the procedure? Note: A review can be accomplished by meeting with employees
individually or in a group.
Not applicable
Revised February 2015
Yes
No
Questions? Contact ehsdept@uw.edu
Appendix D:
Lockout - Tagout (LOTO) Program Review
Annual Review and Training Assessment Checklist
Department:
Shop:
Location:
Equipment:
Yes
1. A) Has there been a change in job assignments, machines, equipment
or processes?
B) If so, have employees been re-trained when job assignments,
machines, equipment or processes have changed?
2. Are the locks uniquely identified, uniquely keyed, and only used for the
purpose of LOTO?
3. Does the tag used with the lock identify the worker servicing the
machine or equipment?
4. Has equipment and machine-specific LOTO procedures been
documented in writing?
5. Does the employee know where the written LOTO procedures are
located?
6. Does the employee notify affected employees and all other employees in
the area before starting the LOTO procedure?
7. Can the employee identify all hazardous energy sources and associated
hazards for the equipment or machine to be locked out?
8. Does the employee follow the proper LOTO procedures for deenergizing the equipment or machine?
9. Does the employee demonstrate the proper steps for the placement,
removal and transfer of LOTO devices?
10. Does the employee use the proper methods to verify the equipment or
machine was de-energized?
11. Before releasing the machine or equipment from LOTO, does the
employee do the following:
A) Inspect the machine or equipment to ensure it is operationally intact?
B) Ensure that all employees are safely positioned?
C) Notify affected employees and all other employees in the area that
the LOTO devices have been removed?
12. If you answered “No” to questions 2-11, has the employee been retrained?
Revised February 2015
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No
Appendix C:
Lockout - Tagout (LOTO) Program Review
Authorized Employees Observed
(Print Name, Job Title and Employee ID)
NAME
Job Title
EID
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Deficiencies Observed & Corrective Actions:
Reviewed By:
Date Reviewed:
Revised February 2015
Job Title: ________________
Questions? Contact ehsdept@uw.edu