DRAFT
SAMPLE WRITTEN
Lockout/Tagout
For Compliance With
Federal Code of Regulations General Rules
and Regulations to meet 29 CFR 1910 and
1926 OSHA Standards
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ACKNOWLEDGMENTS
This material was compiled by the staff of the South Dakota OSHA On-Site Consultation
Program.
NOTE: this sample plan is provided only as a guide to assist in complying with Federal
OSHA's General Rules and Regulations. It is not intended to supersede the
requirements detailed in the guidelines. Employers should review the standard for
particular requirements which are applicable to their specific situation. Employers will
need to add information relevant to their particular facility and industry, and types of
machine(s) and/or system(s), in order to develop an effective program. Employers
should note that certain programs are expected to be reviewed at least on an annual
basis and updated when necessary.
This material and Safety and Health Consultation Services are provided free of charge
to owners, proprietors, and managers of small businesses, by the South Dakota On-Site
Consultation Program, Engineering Extension, South Dakota State University, a
program funded largely by the Occupational Safety and Health Administration (OSHA),
an agency of the U.S. Department of Labor.
The information contained in this document is not considered a substitute for any
provision of the standard.
UPDATED: February 2014
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GUIDE TO COMPLIANCE WITH THE
FEDERAL 29 CFR 1910 AND 1926 LOCKOUT / TAGOUT STANDARD
To ensure a lockout or tagout is performed before attempting any servicing or
maintenance (see definition) of machines/equipment in which the unexpected
energization, start-up, or release of stored energy could cause injury to employees.
Lockout is the preferred method, and will be used when possible, of isolating machines
or equipment from energy sources.
This procedure is to be used when there are limited numbers or types of machines or
equipment or there is a single power source.
For more complex systems, a comprehensive procedure, using the Lockout/Tagout
Sample Evaluation For A Specific Machine Or System (found on page 6 of this
information), will show the documentation for lockout or tagout.
Purpose
Establish Sample Company’s Name procedures to provide employees with a safe and
healthy working environment to prevent injuries to themselves and their co-workers.
Definitions
For the purpose of this Policy and Procedure:
“Servicing or Maintenance” includes activities such as constructing, installing,
setting up, adjusting, inspecting, modifying, and maintaining and/or servicing machine or
equipment. Excluded from coverage are minor tool changes and adjustments, and
other minor servicing activities, which take place during normal production operations, if
they are routine, repetitive and integral to the use of equipment for production, provided
that the work is performed without the removal or bypassing of machine guards already
required by OSHA. When machines or equipment are undergoing repairs or rebuild,
lockout procedures must be used.
“Authorized” employees are workers who lock or implement a tagout system
procedure on the machines or equipment to perform servicing or maintenance on the
machines or equipment.
“Affected” employees are workers who do not perform the servicing or
maintenance, but whose job requires them to work in an area in which servicing or
maintenance is being performed (i.e. operators, other repairmen, Group Leaders).
“Energized” is being connected to an energy source or containing residual or
stored energy.
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“Energy isolating device” is a mechanical device that physically prevents the
transmission or release or energy, including but not limited to the following: A manually
operated electrical circuit breaker; a disconnect switch; a manually operated switch by
which the conductors of a circuit can be disconnected from all ungrounded supply
conductors and, in addition, no pole can be operated independently; a slide gate; a slip
blind; a line valve; a block or isolate energy. The term does not include a push button,
selector switch, and other control circuit type devices.
“Electrical Source” is any source of electrical, mechanical, hydraulic, pneumatic,
thermal, or other energy.
“Lockout” is the placement of a lockout device on an energy-isolating device, in
accordance with an established procedure, ensuring that the energy isolating device
and the equipment being controlled cannot be operated until the lockout device is
removed.
“Lockout device” is that device that utilizes a positive means such as a lock,
either key or combination type, to hold an energy-isolating device in the safe position
and prevent the energizing of a machine or equipment.
“Normal Production Operations” is the utilization of a machine or equipment to
perform its intended production function.
“Servicing and/or Maintenance” Workplace activities such as constructing,
installing, setting up, adjusting, inspecting, modifying, and maintaining and/or servicing
machines or equipment. These activities include lubrication, cleaning or un-jamming of
machines or equipment and making adjustments or tool changes, where the employee
may be exposed to the unexpected energization or startup of the equipment or release
of hazardous energy.
“Setting up” is any work performed to prepare a machine or equipment to perform
its normal production operation.
“Tagout” is the placement of a tagout device on an energy isolating device, in
accordance with an established procedure, to indicate that the energy isolating device
and the equipment being controlled may not be operated until the tagout device is
removed.
“Tagout Device” is prominent warning device, such as a tag and a means of
attachment, which can be securely fastened to an energy isolating device in accordance
with and established procedure, to indicate that the energy isolating device and the
equipment being controlled may not be operated until the tagout device is removed.
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Responsibility
The following employees shall be instructed in the safety significance of the lockout (or
tagout) procedure. See Appendix A of this report for an example of the name(s) / job
title(s) of employees authorized to lockout and tagout.
Each new or transferred affected employee and other employees whose work
operations are or may be in the area shall be instructed in the purpose and use of the
lockout or tagout procedure. See Appendix B of this report for an example for the
name(s) / job title (s) of affected employees, and how to notify.
Preparation for Lockout or Tagout
Sample Company’s Name will make a survey of location and identify all isolating
devices to be certain which switch(s), valve(s) or other energy isolating devices applied
to the equipment to be locked or tagged out. More than one energy source (electrical,
mechanical, or others) may be involved.
Example: (Type(s) and Location(s) of energy isolating means)
1.
2.
3.
4.
Air Compressors - Mechanical & Electrical.
Milling Equipment - Electrical, Mechanical, and Gravity.
Overhead Doors - Electrical, Mechanical, and Gravity.
Overhead Cranes - Electrical, Mechanical, and Gravity.
Procedure for Use of the Lockout / Tagout System
1. Authorized employee will notify Production Supervisor, Group Leader, and affected
employees that a lockout or tagout system is going to be implemented in their work
area and the reason why. The authorized employee shall know the type and
magnitude of energy that the machine or equipment utilizes and will understand the
hazards that are present.
2. If the machine or equipment is operating, shut it down by the normal stopping
procedure (depress stop button, open toggle switch, etc.)
3. Operate the “disconnect switch”, valve, or other energy isolating device so that
equipment is isolated from its energy source(s). Stored energy (such as that is
springs, elevated machine members, rotating flywheels, hydraulic systems, air, gas,
steam, water pressure, electrical capacitors, etc.) must be relieved, dissipated, or
restrained by methods such as repositioning, blocking, bleeding down, etc. (Type(s)
of Stored Energy methods to dissipate or restrain.)
4. Lockout and/or tagout the equipment with energy isolating devices with assigned
individual lock(s) and tag(s). Method(s) selected; i.e., locks, tags, additional safety
measures, etc.
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5. On equipment with electrical disconnects the “disconnect” shall be placed in the
“OFF” position and a padlock added to ensure that it cannot be moved to the “ON”
position.
6. On equipment with cord cap disconnects the cord cap shall be disconnected and a
padlock added to the equipment end of the electrical cord to ensure the electrical
cord cannot be plugged in.
7. On equipment with no cord cap or electrical disconnect the bus duct fuse box shall
be opened and padlocked.
8. After ensuring that no personnel are exposed, and as a check on having
disconnected the energy sources, operate the push button or other normal operating
controls to make certain the equipment will not operate. Make sure to note the
type(s) of equipment that need to be checked to ensure disconnection. CAUTION:
Return operating control(s) to “neutral” or “off” position after the test.
9. Before work is started, equipment must be tested using normal operating controls to
insure it will not operate.
Restoring Machines to Normal Production Operations
1. After the “Servicing or Maintenance” is complete and guards have been reinstalled
and employees are in the clear, remove all lockout devices.
2. After all tools have been removed from the machine or equipment, guards should be
reinstalled.
3. Operate the energy isolating devices to restore energy to the machine.
4. Notify the group leader that the job is completed and ready for inspection.
Procedure Involving More Than One Person
1. In the preceding steps, if more than one individual is required to lockout or tagout
equipment, each shall place his/her own personal lockout device or tagout device on
the energy isolating device(s).
2. When an energy-isolating device cannot accept multiple locks or tags, a multiple
lockout or tagout device (hasp) may be used.
3. Of lockout is used, a single lock may be used to lockout the machine or equipment
with the key being placed in a lockout box or cabinet which allows the use of multiple
locks to secure it.
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4. Each employee will then use his/her own lock to secure the box or cabinet.
5. As each person no longer needs to maintain his or her lockout protection, that
person will remove his/her lock from the box or cabinet.
Sequence of Lockout
(1.) Notify all affected employees that servicing or maintenance is required on a
machine or equipment and that the machine or equipment must be shut down and
locked out.
(2.) For the machines or equipment listed below (which have more than one source of
energy requiring lockout), refer to the attached machine/equipment-specific
procedures for the specific procedures to be followed for locking-out the machine
or equipment. Those machines or equipment with specific procedures are:
1.
4.
2.
5.
3.
6.
(The intent here is for you to develop machine-specific procedures, required for
multiple energy source equipment, and attach them to this program.)
(3.) If the machine or equipment is operating, shut it down by the normal stopping
procedure (depress stop/off button, open switch, close valve, etc.).
(4.) De-activate the energy isolating device(s) (main switch, circuit breaker, flow/control
valve, etc) so that the machine or equipment is isolated from the energy source.
(5.) Lockout the energy isolating device(s) with assigned individual lock(s). If more
than one person is exposed to the hazard or is working on the machine or
equipment, each person must attach their individual lock. Only the person who
attaches the lock is authorized to remove their lock.
(6.) Dissipate or restrain any stored or residual energy (such as that in capacitors,
springs, elevated machine member, rotating flywheels, hydraulic systems, and air,
gas, steam or water pressure, etc.) by such actions as grounding, repositioning,
blocking, bleeding down, etc.
(7.) Ensure that the machine or equipment is disconnected from the energy source(s)
by first checking that no persons are exposed, then verify the machine or
equipment is isolated by operating the push/on button or other normal operating
control(s) or by testing to make certain the machine or equipment will not operate.
Return operating controls to neutral or off position after verifying the isolation of the
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machine or equipment. For any electrical work, voltage checks will be made of any
circuit elements and electrical parts on which work is to be performed and any
exposed adjacent parts.
(8.) The machine or equipment is now locked out, and servicing or maintenance may
proceed.
Basic Rules Applying to Lockout Procedure
1. Anytime more than one person is performing “Servicing or Maintenance” on a piece
of equipment at the same time, each shall place his/her own padlock on the energyisolating device, using the procedure above.
2. No one other that person(s) placing padlock(s) on energy isolating devices shall
remove padlocks and restore power.
3. Of work is not completed within one shift and the oncoming shift will continue to
work, the padlock(s) will be removed in the presence of the oncoming shift and
replaced immediately by their own.
4. It shall be the responsibility of the Supervisor/Group Leader to enforce this policy in
their area.
5. The employer must provide training to all authorized and affected employees to
ensure the policy is understood. A training record must be kept, by the Safety
Director.
Basic Rules for Using Lockout or Tagout System Procedure
1. All equipment needs to be locked out or tagged out to protect against accidental or
inadvertent operation when such operation could cause injury to personnel.
2. Do not attempt to operate any switch, valve, or other energy-isolating device where it
is locked or tagged out.
_______________________________
Plant Manager
_______________________________
Safety Director
____________________________
Date
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Appendix A
List of Authorized Lockout and Tagout Individuals
_____________________________________________________________________
Work Center
Lock #
Name
Mechanical
Electrical
Examples:
Maintenance
1
John Doe
Yes
Yes
Plant Manager
2
Joe Manager
Yes
Yes
Assistant Mgr.
Group
Joe Assistant
Yes
No
NOTE: AUTHORIZED ELECTRICAL LOCKOUT / TAGOUT REQUIRES QUALIFIED
WORKER IN ACCORDANCE WITH SUBPART “S” 29 CFR 1910.
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Appendix B
List of Affected Employees by Job Titles
Job Title
Machinery, Equipment or Process
Example:
Production
Milling equipment office air compressor, Overhead cranes
(exposure because of hazards as they are traveling to the break
room.)
Deliver Staff
Overhead cranes, Forklifts, Air Compressors
Forklift Oper.
Overhead cranes, Forklifts, Air Compressors
Custodial
All equipment in Production Shops
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List of Other Employees Exposed to Tagout Conditions
This Applies Only Where Lockout Cannot Be Achieved or Used
Job Title
Machinery, Equipment or Process
Example:
Custodian
Overhead shipping/receiving doors, Electrical circuit breakers used
when repairs to overhead work lights in the production shops.
Office Staff
Electrical circuit panels
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Appendix C
Annual Evaluation Report
Date(s) of Evaluation: ___________________________________________________
Evaluation was made by: ________________________________________________
(Print Name)
General policy has been reviewed: YES / NO (Circle One)
Comments on General Policy:
The Following Specific Procedures Have Been Reviewed (List Below):
The Following Specific Procedures Were Modified (List Below):
The Following Specific Procedures Were Added (List Below):
A review of the log of occupational injuries and illnesses (OSHA 200 Form or
equivalent) and the associated accident reports and injury/illness reports (OSHA Form
101 or equivalent):
YES / NO (Circle One)
The following injuries resulted from problems with the Lockout / Tagout procedures or
equipment. (List Below):
If injuries are listed above, indicate procedure number for applicable equipment,
process or machinery (List Below):
NOTE: These procedure shall be reviewed and modified as necessary:
Comments:
_________________________________
Signature/Title
___________________
Date
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Appendix D
List of All Lockout Procedures
Procedure No.
Equipment, Machinery or Process
Example:
L/O # 001-001
L/O # 001-002
Air Compressors (Hazards are Electrical and Compressed Air)
 Apply lockout lock on electrical disconnect boxes.
 Apply lockout lock on the pneumatic lockout valve.
 Bleed off built up air pressure in system
 Test system to verify no hazardous energy
Overhead Crane (Hazards are Electrical, Gravitational)
 Apply lockout lock on electrical disconnect box
 Apply tagout tag on the hand held control, to bring awareness
to repair being performed)
 Use chains, blocks, and locks to held and part that could fall
 or move to cause injury due to gravity
 Test system to verify no hazardous energy
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
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Appendix E
List of All Tagout Procedures
Procedure No.
Equipment, Machinery or Process
Example:
T/O # 002-002
Overhead shipping/receiving doors (Hazards are electrical and
mechanical movement of doors)
 Apply tagout tag to electrical panel cover, to circuit breaker
(Buddy Clip), and to the control switch of overhead doors to
bring awareness of repairs in progress.
 Apply a block to hold door into place to stop mechanical or
gravity movement of door which may cause crushing injuries.
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
L/O #
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Appendix F
Methods of Tag and Lock Identification
Number of lock sequentially (1,2,3 etc.). Record lock number on the appendix A sheet
to identify employee assigned. All locks will be of __________________ brand name.
One key will be issued to the employee and the second key will be destroyed or in
control in the following method.
Tags used for Tagout will always be secured by a nylon self-locking tie, which will
require cutting the nylon self-locking tie to be removed.
Place name on tagout tags permanently. The use of a wax pencil is recommended for
marking the date on the tagout tag that it was applied.
Notice the samples, taped onto this sheet below, of the tagout tags used by this
company. Note: Other methods of identifying locks and tags are acceptable. These
other methods are specified in 29 CFR 1910.147 (c) (5).
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Appendix G
Outside Contractors
All outside contractors performing work on the company property will follow all
requirements of this Lockout / Tagout - Electrical Safety Related Work Practices
Program or will implement a program of their own that provides the same or higher
protection to the employees of this company. All outside contractors will be provided
with the training needed to perform proper lockout/tagout procedures for this workplace
before actual work by that contractor will be allowed to start.
Example:
Contractor’s Name
Date Discussed
and Trained
A-B-C Mechanical Contractor
01/28/92
Y-Z Welding Services
01/10/92
M - Electrical Services
1/02/92
Signature
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Electrical Safety Related Work Practices
Lockout / Tagout Procedures
If Employees are Exposed to Live Electrical Energy
See the regulation statement included in the 1910 SUBPART S Electrical Safety
Related Work Practices regulation section 1910.333 (b).
Only authorized employees will work on or near exposed energized electrical parts.
See 1910.333 (c) for regulation statements to use in your company lockout / tagout
program for instances of work being performed on exposed live parts or work near
enough to those parts to present a potential hazard.
Possible Additional Statements That May Need To Be Included In The Written Program
Are As Follows:
 Company policy on management removal of lockout / tagout tags and the
procedure that must be followed.
 Company policy on multiple shifts that employees may be using lockout / tagout
items.
 Company policy on group lockout / tagout methods.
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