LOCKOUT/TAGOUT PROCEDURES

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--- HAZARD IDENTIFICATION & RISK ASSESSMENT ---
[ ] Describe the specific agricultural equipment/system to be serviced.
[ ] Identify Potential Energy Sources (check all that apply): (Electrical (e.g., 220V, 480V), Hydraulic Pressure, Pneumatic Pressure, Mechanical (e.g., Flywheels, Gears), Gravitational Potential (e.g., Conveyors), Stored Chemical Energy (e.g., Propane, Fertilizer), Other (Specify in LONG_TEXT))
[ ] If 'Other' energy source was selected, please specify:
[ ] Maximum Hydraulic Pressure (PSI):
[ ] Maximum Pneumatic Pressure (PSI):
[ ] Voltage (Volts):
[ ] Describe any unusual or non-obvious hazards associated with this equipment.
[ ] Risk Level Assessment (Based on severity and likelihood): (Low, Moderate, High)
[ ] Document any control measures implemented to reduce risk (e.g., physical barriers, guards).
[ ] Location of Equipment being assessed

--- EQUIPMENT SPECIFIC PROCEDURES ---
[ ] Procedure for Tractor PTO Lockout
[ ] Procedure for Combine Harvester Engine Shutdown & Lockout
[ ] Procedure for Sprayer Pump Lockout & Tagout
[ ] Procedure for Irrigation Pump Lockout (Diesel or Electric)
[ ] Procedure for Grain Dryer Lockout/Tagout
[ ] Engine RPM before Shutdown (for verification)
[ ] Hydraulic System Isolation Method (Valve Closure, Line Bleed, Other (Specify))

--- LOCKOUT/TAGOUT DEVICE APPLICATION ---
[ ] Energy Isolating Device Type(s) Used: (Disconnect Switch, Circuit Breaker, Valve (Hydraulic/Pneumatic), Valve (Electrical Control), Gear/Clutch, Other - Specify in LONG_TEXT)
[ ] Specific Details Regarding Lockout/Tagout Device Application (e.g., specific lock type, valve position):
[ ] Number of Lockout Devices Applied:
[ ] Lockout Device Placement: (Directly on Energy Isolating Device, On Hasp/Lockbox, Other - Specify in LONG_TEXT)
[ ] Describe how the lockout device is secured and prevents unintentional release:
[ ] Which of the following are applied to the energy isolating device? (Lock, Tag, Hasps, Bleed-down procedures applied)
[ ] Tag Condition: (New, Used (Reusable), Damaged - Replace)
[ ] Any unique considerations for this specific lockout?

--- VERIFICATION OF ISOLATION ---
[ ] Describe the method used to verify zero energy state (e.g., voltage testing, visual inspection, pressure gauge readings).
[ ] Voltage reading after lockout (if applicable).
[ ] Pressure reading after lockout (if applicable - PSI, kPa, etc.).
[ ] Was the machine/equipment moved or started during verification? (Yes, No)
[ ] Which verification steps were performed? (Visual Inspection of Isolation Points, Voltage Testing, Pressure Gauge Reading, Sound Test (e.g., listening for residual power), Other (Specify))
[ ] If 'Other' was selected in previous element, please specify the verification method.
[ ] Time of Isolation Verification
[ ] Was isolation successful? (Yes, No)
[ ] If isolation was not successful, describe the corrective action taken.
[ ] Signature of Verifier

--- EMPLOYEE TRAINING & AUTHORIZATION ---
[ ] Initial Training Date
[ ] Refresher Training Date
[ ] Training Hours Completed
[ ] Training Topics Covered (Select all that apply) (General LOTO Principles, Equipment-Specific Procedures, Group LOTO, Contractor LOTO, Hazard Identification, Lockout Device Application)
[ ] Authorized Employee Status (Authorized, Not Authorized)
[ ] Trainer Name and Credentials
[ ] Training Certificate/Documentation (Optional)
[ ] Employee Signature
[ ] Supervisor Signature

--- PERIODIC INSPECTION & MAINTENANCE OF LOTO EQUIPMENT ---
[ ] Last Inspection Date
[ ] Inspection Performed By (Role) (Authorized Employee, Safety Personnel, Maintenance Personnel)
[ ] Number of Lockout Devices Inspected
[ ] Lockout Devices Condition (Select all that apply) (Intact, Damaged, Missing, Corroded, Functioning Properly, Not Functioning Properly)
[ ] Notes on Lockout Device Condition/Repairs Needed
[ ] Tag Condition (Intact, Faded, Missing, Damaged)
[ ] Number of Tags Verified
[ ] Next Inspection Due Date
[ ] Inspector Signature

--- GROUP LOCKOUT/TAGOUT PROCEDURES ---
[ ] Reason for Group Lockout/Tagout
[ ] Authorized Personnel Involved (Select All That Apply) (Mechanic, Electrician, Operator, Maintenance Supervisor, Other (Specify Below))
[ ] If 'Other' Selected Above, Please Specify:
[ ] Number of Locks/Tags Applied
[ ] Lockout Device Type (Primary) (Padlock, Ball Valve Lockout, Hasps, Circuit Breaker Lockout, Other (Specify Below))
[ ] If 'Other' Selected Above, Please Specify:
[ ] Date of Group Lockout
[ ] Time of Group Lockout Initiation
[ ] Signature of Initial Lockout Person (Person 1)
[ ] Signature of Second Lockout Person (Person 2)

--- CONTRACTOR LOCKOUT/TAGOUT PROCEDURES ---
[ ] Contractor LOTO Orientation Completion (Completed, Not Completed)
[ ] Contractor Review of Site-Specific LOTO Procedures
[ ] Contractor Employee Number Involved in LOTO
[ ] Contractor Authorization to Perform LOTO (Authorized, Not Authorized)
[ ] Description of Communication Plan Between Site Personnel and Contractor Regarding LOTO
[ ] Contractor LOTO Permit (if applicable)
[ ] Contractor Provided LOTO Devices Used? (Yes, No)

--- SHIFT CHANGE PROCEDURES ---
[ ] Incoming Shift Start Time:
[ ] Outgoing Shift End Time:
[ ] Brief Summary of Current Lockout/Tagout Status (Outgoing Shift):
[ ] Specific Equipment Currently Locked Out/Tagged Out:
[ ] Energy Sources Currently Isolated (Select all that apply): (Electrical, Hydraulic, Pneumatic, Mechanical, Gravity, Thermal)
[ ] Lockout/Tagout Status Verified By Incoming Shift Personnel? (Yes, No)
[ ] Name of Incoming Shift Personnel Verifying Lockout/Tagout:
[ ] Signature of Incoming Shift Personnel Verifying Lockout/Tagout:

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