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LOCKOUT TAGOUT POLICY AND PROCEDURES <br />livingcenters <br />Attachment "A" <br />Lockout/Tagout <br />Equipment Isolation Procedure Form <br />Department: I <br />Supervisor: <br />Date: <br />Equipment: <br />Energy sources and location: <br />Type of lock or energy control device: <br />Authorized employee(s): <br />Affected employee(s): <br />Procedure developed by: <br />Sequence of events for lockout/tagout: <br />1. Notify affected employee(s). <br />2. If equipment is running, shut it down, following normal procedures. <br />3. Determine the types of hazardous energy present. <br />4. Locate energy isolation devices for each type of hazardous energy, shut off and <br />lock and tag -out. <br />5. Verify the equipment is de -energized b <br />6. Perform service and/or repair. <br />7. Inspect equipment area around equipment before re -energizing. <br />8. Make sure equipment is in the off position. <br />9. Notify affected employee(s) before removing locks and tags. <br />10. Remove locks and tags and re-energize equipment by normal start-up <br />procedure. <br />Ensure that e uipment starts up properly. <br />Golden Living LOCKOUTITAGOUT Page 6 of 10 <br />