Sample Energy Control Program

Lockout Tagout Program

Sample Written Program

This sample Lockout Tagout (LOTO) Program is provided by the Missouri On-Site Safety and Health Consultation Program. In order to comply with OSHA’s standard for Control of Hazardous Energy, 29 CFR 1910.147, this written plan must be site specific. Modify the template to reflect the policies and procedures at your company. Since OSHA regulations set minimum requirements, you may choose to add additional information to your site specific program. There is no requirement to follow this sample and its use does not guarantee compliance with the OSHA standard.

To prepare your plan, follow these steps:

1. Read The Control Of Hazardous Energy Standard 29 CFR 1910.147

2. The following information may be useful in developing your program:

3. Add information to make it site specific to your company.

4. For clarification or assistance, contact the Missouri On-Site Safety and Health Consultation at 573-522-SAFE.

 

Lockout Tagout Program

(To customize, please complete and remove the highlighted areas of the program)

Date Created:

Date Reviewed:

1. Company Policy

(Name of company) is committed to providing a safe and healthful work environment for our entire staff.  This program establishes the requirements for the lockout of energy isolating devices whenever servicing or maintenance is performed on machines or equipment. It will be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine or equipment or release of stored energy could cause injury.

2. Program Administration

(Name of person or job title) will maintain, review, and update the Lockout Tagout (LOTO) Program at least annually, and whenever necessary to include new equipment or whenever major replacement, repair, renovation or modification of machines or equipment is performed, and whenever new machines or equipment are installed.

The LOTO Program will:

  • Establish an energy control program
  • Develop, document and utilize LOTO procedures
  • Provide employees appropriate training
  • Provide, at no cost to employees, equipment required by the Energy Control Procedures

  • Ensure continuing competency through training

3. Program Review and Update

The LOTO Program will be reviewed or updated at least annually, or whenever there are new equipment, or personnel changes that might affect the program. Annually, authorized employees who are not involved with the procedures being inspected, will conduct a review of the Energy Control Procedures for all machines and equipment. 

The annual inspection will include:

  • A review between the inspector and each authorized employee of that employee's responsibilities under the Energy Control Procedure
  • A physical inspection of the authorized employee while performing work under the procedures in order to correct any deviations or inadequacies identified

  • A written certification by the inspector identifying the equipment or machine being inspected, the date of the inspection, the employees included in the inspection, and person performing the inspection.

4. Responsibility

All employees (authorized, affected, or others) are required to comply with the requirements of our LOTO Program.

  • Authorized employees shall be knowledgeable about the Energy Control Procedure for each piece of equipment, the type and magnitude of the energy that each piece of equipment utilizes, and the hazards of the energy. Authorized employees are identified on each Energy Control Procedure Form.

  • Affected Employees and any other employees whose work operations are or may be in the area, will be knowledgeable about the purpose and the use of the Energy Control Procedure and the prohibitions against attempting to restart the equipment during lockout. Affected employees are identified on each Energy Control Procedure Form.
  • Other Employees who do not work in areas where lockout may be used will be provided a brief overview of the LOTO Program.


All employees, upon observing a machine or piece of equipment is locked out for servicing or maintenance work, shall not attempt to start, energize or use that machine or equipment. Employees shall consult with management whenever there are any questions regarding the Energy Control Procedures or methods. Management shall enforce the Energy Control Procedures including the use of corrective disciplinary action when necessary.

5. Methods of Compliance

Preparation for Lockout:

  • The authorized employee shall obtain the proper Energy Control Procedure Form located in (Location) and review it before attempting to lockout a machine or equipment.

Lockout or Tagout System Procedure:

  • The authorized employee (in conjunction with the Qualified Employee if necessary) shall perform the lockout procedure as written on the Energy Control Procedure Form for the equipment being serviced, using the listed order given in the written procedure.

Group Lockout Procedures:

  • This procedure will afford the same level of protection for each employee that is provided by the implementation of a personal lockout device
  • One authorized employee selected by the (Name of person or job title) will coordinate the lockout procedure for all group lockouts
  • These rules as well as the Energy Control Procedure Form for the specific piece of equipment will be reviewed with all authorized and affected employees by the group coordinator prior to the lockout
  • Each employee will affix their lock to the equipment being serviced
  • No employee will be allowed to remove another employee's lock. Each employee will remove their own lock when their part of the operation is complete
  • When servicing or maintenance will involve more than one shift, the off-going shift will remove their locks as the oncoming shift applies their locks
  • When equipment has only enough room for one lock, the group coordinator will place the lock on the equipment and then place the key to that lock in a cabinet or box and each authorized employee will then affix their lock to the cabinet or box
     

Shift or Personnel Changes:

  • During shift change or when the authorized employee currently performing the repair must leave before their replacement arrives, the (Name of person or job title) shall place their lock on the equipment and then the authorized employee will remove their lock.  The (Name of person or job title) will remove their lock after the replacement authorized employee has placed their lock on the equipment.
  • Where the replacement employee is present during the time that the current authorized employee is preparing to leave, the replacement employee will place their lock on the equipment and then the current employee will remove their lock.

Outside Service or Contractor Personnel:

Outside personnel or contractors shall be advised that the company has and enforces the use of Energy Control Procedures.  They will be informed of the use of locks and tags and notified about the prohibition of attempts to restart or re-energize machines or equipment that are locked out or tagged out.

The company will obtain information from the outside personnel or contractor about their Energy Control Procedures and will advise affected employees of this information.

Testing or Positioning of Equipment during Lockout:

  • In situations in which lockout devices must be temporarily removed from the energy isolating device (because the machine or equipment must be energized to test or for positioning,) the authorized employee shall consult the Energy Control Procedure Form and follow the sequence of actions listed for Restoring Equipment to Service. Once the testing or positioning is complete and before servicing or maintenance is continued, deenergization following the steps on the Energy Control Procedure Form shall be reinstituted.
     

6. Training

Employees will be provided training to ensure they know the purpose and function of the LOTO Program are understood along with the knowledge and skills required for the safe application, usage, and removal of the energy controls.

Authorized employees will be trained on the following:

  • Recognition of applicable hazardous energy sources;
  • The type and magnitude of the energy available in the workplace; and
  • The method and means necessary for energy isolation and control based on the Energy Control Procedure Forms.


Affected employees will be trained on the following:

  • The purpose and use of the Energy Control Procedure.


Other employees whose work operations are or may be in an area where Energy Control Procedures may be utilized will be instructed on the following:

  • The procedure and the prohibitions against attempting start-up of any locked out equipment.


Qualified employees (those permitted to work on or near exposed energized parts) shall, at a minimum, be trained in and familiar with:

  • The electrical Energy Control Procedures;
  • The skills and techniques necessary to distinguish exposed live parts from other parts of electrical equipment;
  • The skills and techniques necessary to determine the nominal voltage of exposed live parts;
  • The appropriate clearance distances specified in 29 CFR 1910.333 (c) and the corresponding voltages to which the Qualified Person will be exposed; and
  • Appropriate Personal Protective Equipment provided by (Name of company) and identified in the PPE Hazard Assessment.


Authorized and qualified employees will be given training prior to any initial involvement in the lockout procedures.  Affected employees will be given training at the time of hiring.

Retraining will be given whenever there is a change in:

  • Job assignment;
  • A change in machine, equipment or processes that would create a new hazard; or
  • Whenever a change would occur in the (Name of company)'s Energy Control Procedures.


A list of employees trained, type of training, and dates of training will be maintained by (Name of person or job title).

7. Energy Control Procedure

Energy Control Procedures shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine, or equipment, or release of stored energy could cause injury.

LOTO Locks

LOTO devices will be standardized by either color, shape or size. These devices will be substantial enough to prevent removal without the use of excessive force (such as bolt cutters). The devices will also identify who had applied them by a tag or other equally effective means.

Sequence of Lockout

  • Notify all affected employees that servicing or maintenance is required on a machine or piece of equipment and that the machine or equipment must be shut down and locked out to perform the servicing or maintenance.

(Name(s)/Job Title(s) of affected employees and how to notify on the Energy Control Procedure Form.)

  • In preparation for shutdown, the authorized employee shall refer to the company's detailed Energy Control Procedure Form:
    • For each type of machine or piece of equipment to be locked out
    • To identify the type and magnitude of the energy that the machine or equipment utilizes
    • To understand the hazards of the energy
    • To know the methods to control the energy
  • If the machine or equipment is operating, shut it down by the normal stopping procedure (for example: depress the stop button, open switch, close valve, etc. Remember to include the specific normal stopping procedure for each machine or piece of equipment on the Energy Control Procedure Form). 
  • De-activate the energy isolating device(s) so that the machine or equipment is isolated from the energy source(s). On the Energy Control Procedure Form, list the types and locations of energy isolating devices, such as switches, circuit breakers, line valves, blocks, or any mechanical device that physically prevents the transmission of release of energy.
  • Lock out the energy isolating device(s) with assigned individual lock(s). 
  • Stored or residual energy (such as that in capacitors, springs, elevated machine members, rotating flywheels, hydraulic systems, air, gas, steam, water pressure, etc.) must be dissipated or restrained by methods such as grounding, repositioning, blocking, bleeding down, etc. 
  • Ensure that the equipment is disconnected from the energy source(s) by first checking that no personnel are exposed, then verify the isolation of the equipment by operating the push button or other normal operating control(s) or by testing to make certain the equipment will not operate.  Caution: Return operating control(s) to neutral or "off" position after verifying the isolation of the equipment.
  • For deenergized conductors or parts of electrical equipment only: If a lock cannot be applied, a tag may be used by the qualified employee without a lock if it is supplemented by at least additional safety measure that provides a level of safety equivalent to that obtained by the use of a lock.  List the safety measures to be used (i.e. the removal of an isolating circuit element, blocking of a controlling switch, or opening of an extra disconnecting device).
  • For deenergized conductors or parts of electrical equipment only: A qualified employee (one who is familiar with the construction and operation of the equipment and the electrical hazards involved) shall use test equipment to test the circuit elements and electrical parts of equipment to which employees will be exposed and shall verify that the circuit elements and equipment parts are deenergized.  The test shall also determine if any energized condition exists as a result of inadvertently induced voltage or unrelated voltage backfeed even though specific parts of the circuit have been deenergized and presumed to be safe.  If the circuit to be tested is over 600 volts, nominal, the test equipment shall be checked for proper operation immediately before and immediately after this test. (List the qualified person and the testing instrument to be used.)
  • The machine or equipment is now locked out.


Restoring Equipment to Service

When the servicing or maintenance is complete and the machine or equipment is ready to return to normal operating condition, the following steps shall be taken:

  • Check the machine or equipment and the immediate area around to ensure that nonessential items have been removed and that the machine or equipment components are operationally intact;
  • Check the work area to ensure that all employees have been safely positioned or removed from the area;
  • Verify that the controls are in neutral;
  • Remove the lockout devices and reenergize the machine or equipment;

Note: The removal of some forms of blocking may require reenergization of the machine before safe removal.

  • Notify affected employees that the servicing or maintenance is completed and the machine or equipment is ready for use.


Compliance with this Program

All employees are required to comply with the restrictions and limitations imposed upon them during the use of lockout.  The authorized employees are required to perform the lockout in accordance with Energy Control Procedures. All employees, upon observing a machine or piece of equipment which is locked out to perform servicing or maintenance shall not attempt to start, energize, or use that machine or equipment. Employees who fail to adhere to this policy will automatically be disciplined by our (Name of company) ’s progressive disciplinary policy.

(List the name(s)/job title(s) of "authorized" employees here) 

 

 

 

 

 

 

 

 

Energy Control Procedure Form

 

Location:

Machine (Type, Manufacture, Model and Serial Number):

Date Created:

Date Revised:

Procedure Completed By:

Authorized Employees

Affected Employees

 

 

 

 

 

 

Energy Sources

Electric      Hydraulic     Pneumatic      Mechanical      Steam      Gravity    

  Chemical      Natural Gas       Stored Energy      Other (Explain)

Type of Energy Isolating Device

Location

Capable of being Locked Out? (Yes/No)

 

 

 

 

 

 

 

 

 

 

 

 

Shutdown Procedures:

 

 

 

 

Deenergization Confirmation Procedure:

 

 

 

Startup Procedure:

 

 

 

 
       

 

Annual Inspection Certification Form

Note: The Inspector must observe utilization of the procedure by the authorized employee(s).

 

Date of Inspection:

Inspector (Authorized Person):

Machine/Equipment:

Authorized Employee:

Were all the hazardous energy sources properly identified in the written procedure?         YES      NO    If no, explain:

 

 

Were the energy isolation steps outlined in the procedure effective in isolating all the sources of stored energy?      YES      NO    If no, explain:

 

Were the proper lockout/tagout devices (padlocks, plug locks, valve cover locks, blocks, breaker locks, tags, etc.) available to effectively perform the energy isolation procedure?  YES      NO    If no, explain:

 

Did the authorized employee(s) deviate from the lockout/tagout procedure?

 YES      NO    If yes, explain:

 

Did all authorized employees participating in the inspection understand their responsibilities under the procedure?       YES      NO    If no, explain:

 

Was the procedure adequate to provide the necessary protection?       YES      NO    

If no, explain:

 

Certification:  I certify that this periodic inspection was performed in conformity with the information set forth herein. 

Inspector’s Signature:

 

 

LOTO Training Roster

Training Performed By:

 

Employee Name

Employee Signature

Training Date