Louisiana Administrative Code
Title 28 - EDUCATION
Part CXXXIII - Bulletin 1674 - Safety Manual for Career and Technical Education Programs
Chapter 25 - Mechanical Hazards Worksheet
Subchapter B - Hazard Identification
Section CXXXIII-2513 - Control of Hazardous Energy Sources (Lockout/Tagout)

Circle the Appropriate Answer

1. Does the program require that all hazardous energy sources be isolated, locked or tagged, and otherwise disabled before anyone performs any activity where the unexpected energization, startup, or release of stored energy could occur and cause injury?

Y N N/A

2. Have procedures been developed, documented, and implemented for the control of hazardous energy when working with such equipment?

Y N N/A

3. Do the procedures clearly outline the scope, purpose, responsibility, authorization, rules, and techniques to be applied to the control of hazardous energy, and measures to enforce compliance?

Y N N/A

4. Do procedures exist for shutting down, isolating, blocking, and securing (locks and tags) energy?

Y N N/A

5. Do procedures exist and is someone assigned responsibility for removing and transferring locks and tags?

Y N N/A

Circle the Appropriate Answer

1. Are locks, tags, chains, adapter pins, or other hardware available for securing or blocking energy sources?

Y N N/A

2. Are these devices standardized in either color, shape, size, or format?

Y N N/A

3. Do these devices have a provision for identifying the person applying the device?

Y N N/A

4. Do tagout devices or danger tags warn against hazardous conditions if the equipment is re-energized?

Note: Acceptable wording includes Do Not Open, Do Not Start, Do Not Close and Do Not Energize

Y N N/A

Circle the Appropriate Answer

1. Are inspections conducted at least annually by an authorized person (other than the ones using the energy control procedures) to ensure control procedures are being implemented?

Y N N/A

2. Is each inspection certified by identifying:

a. the machine or equipment on which the energy control procedure was being used;

b. the date of the inspection; and

c. the person performing the inspection?

Y N N/A

Circle the Appropriate Answer

1. Is training provided and documented to ensure that:

a. the purpose and function of the energy control procedures are understood; and

b. the knowledge and skills required for the safe application and removal of energy controls are acquired?

Y N N/A

2. Is this training repeated periodically when changes or deviations occur in the energy control procedure?

Y N N/A

Circle the Appropriate Answer

1. Are all energy-isolated devices operated only by authorized persons or under the direct supervision of an authorized person?

Y N N/A

Circle the Appropriate Answer

1. Are all employees notified of the application and removal of lockout and tagout controls whenever such controls directly affect their work activities?

Y N N/A

Circle the Appropriate Answer

1. Does the application of energy control follow the sequence listed below?

Step 1. Machine or equipment shutdown by authorized personnel.

Step 2. Machine or Equipment Isolation. All energy-isolated devices that are needed shall be located and operated in a manner that isolates the machine or equipment from the energy source(s).

Step 3. Lockout and Tagout Application

i. Lockout devices shall be affixed in a manner that will hold the energy-isolating device in a safe or off position.

ii. Tagout devices shall be affixed in a manner that clearly indicates that the operation or movement of energy isolating devices from the safe or off position is prohibited.

iii. If a tag cannot be affixed directly to the energy isolating device, the tag shall be located as close as safely permissible to the device, in a position that will be immediately obvious to anyone operating the device.

Step 4. Stored Energy. Following the application of lockout and tagout devices, all hazardous, stored, or residual energy shall be relieved, disconnected, restrained, or otherwise rendered safe.

Step 5. Verification of Isolation. Before starting work on the isolated equipment or process, an authorized person must verify that isolation and de-energization of the machine or equipment has been accomplished.

Y N N/A

2. Has the work area been inspected before the removal of lockout and tagout devices?

Y N N/A

3. Has the lockout and tagout device been removed by the person who put it on?

Note: This rule has some limited exceptions.

Y N N/A

4. Are outside servicing personnel informed of the lockout and tagout procedures before equipment is serviced?

Y N N/A