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Removing (Cutting Off) A Safety Lockout Lock: (Must Be Completed Prior To Removing The Lock)

This document outlines the procedure for removing a safety lockout lock. It requires that two supervisors from different levels evaluate the equipment and agree it is safe to energize. They must sign off, along with noting the date, time, and reason for removing the lock since the owner cannot. All steps to ensure no employees are present must be checked, such as calling and looking for the owner. The incident then must be reviewed with the owner and discipline administered if needed.

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135 views1 page

Removing (Cutting Off) A Safety Lockout Lock: (Must Be Completed Prior To Removing The Lock)

This document outlines the procedure for removing a safety lockout lock. It requires that two supervisors from different levels evaluate the equipment and agree it is safe to energize. They must sign off, along with noting the date, time, and reason for removing the lock since the owner cannot. All steps to ensure no employees are present must be checked, such as calling and looking for the owner. The incident then must be reviewed with the owner and discipline administered if needed.

Uploaded by

wiss gader
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Removing (cutting off) a safety Lockout Lock

(Must be completed prior to removing the lock)

Two designated plant supervisors must fully evaluate the equipment and concur that no employee
will be injured upon removal of the lock and energization of the equipment. Two functional levels of
supervision are preferred (i.e., maintenance supervisor and plant manager). If impractical, approval
by two vertical levels of supervision (i.e., production shift supervisor and maintenance supervisor)
is acceptable.

Date: ______________ Equipment: _________________________________________

Name of Lock Owner: ________________________________Lock Number: _____________

___________________________ _________________________ __________ ________


Requestor Signature Date Time cut

___________________________ _________________________ __________


Department Manager (or Supervisor) Signature Date

___________________________ _________________________ __________


* Second Manager (or Supervisor) Signature Date
* The second Manager should be one of the following: Maintenance
Manager, Maintenance Supervisor, Department Manager, or Superintendent.

What is the reason why the lock owner cannot remove the lock? ___________________________

______________________________________________________________________________

Why must the lock be cut off? ______________________________________________________

______________________________________________________________________________

All steps to be taken to assure that the employee is not on site. (check each box)
 Verify if employee’s supervisor or Manager is on site. If available, that supervisor/manager
needs to be involved in this process.
 Go to the area and look for the employee. Ask other employees in the area if the lock
owner is still here.
 Page or call the employee.
 Check the time clock for an out punch.
 Verify that all employees are clear and that there is no safety or other reason that the
equipment must remain locked.
 Verify that all tools, parts, debris clear.
 Verify that all guards in place.

This incident must be reviewed with the lock owner prior to starting work on the next
scheduled workday. Appropriate discipline should be administered.

Forward this completed form to the Safety Office along with the cut lock

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