INSERT AREA NAME HERE Lock Out Tag Out (LOTO) Energy Isolation Procedure – INSERT EQUIPMENT NAME HERE

Information: This is a LOTO procedure for the isolation of the (EQUIPMENT NAME), located in (LOCATION DETAILS HERE). This document provides the necessary steps and instructions to be taken to isolate the plant from hazardous energy sources for safety, maintenance, inspection and repair purposes.

Plant Reference Photo(INSERT PICTURE HERE)

Location: Insert Specific Location Details HereWho can LOTO/Isolate this plant: Isolation is able to be completed by the following personnel:

Employee Name (Position Title); Employee Name (Position Title);

All instances of LOTO/isolation must be completed or supervised by the plants Responsible Officer, (INSERT NAME). This includes the reason for isolation and the expected isolation period.

Prepare the Equipment for Isolation:1. Document the steps in preparation for isolation, such as deactivating operator controls, plant shutdown, etc.;2.3.4.5.6.

Use of ‘Out of Service’ and ‘Danger’ TagsTags must be secured to machines (at sources of energy) after physical implementation of isolation devices. Out of Service tags are required to indicate that the condition of plant is unsafe. Danger tags must be used to warn staff/operators of the danger to individuals (such as service technicians, etc.) working on the plant. Each individual working on the plant must use their own tag and lock at each isolation point.

Danger Tag Out of Service Tag

Used to alert people of the danger to personnel working on the plant;

Must include information such as name/organisation of the issuer, phone number, date of issue;

Multiple tags must be used; one for each individual working on the plant at each point of isolation;

May only be removed by the personnel who placed and signed the tag after the completion of work.

Tagged equipment must not be used;

Used to indicate out of service plant that requires repair;

Must include information such as name/organisation of the issuer, phone number, date of issue and reason why the plant is out of service;

May be removed by authorised persons if the plant is safe to return to service and after consultation with the plants responsible officer;

Not to be used in conjunction with Danger tags;

Tagged equipment must not be used;

Isolation of Plant LOTO Template, v1 Responsible Officer: Manager, OH&S Page 1 of 2Date Effective: May 2020 Date of next review: April 2022

For the latest version of this document please go to: http://www.monash.edu.au/ohs/

Energy Sources and Isolation Points (INCLUDE PHOTOS OF PLANT AND THE ISOLATION POINTS)WARNING: All isolated sources must be labelled with a completed “Danger” or “Out of Service” tag.

Identify energy sources and isolation points1: List type of Hazardous Energy: – list isolation point and hazardous energy type.2: List type of Hazardous Energy:3: List type of Hazardous Energy:4: List type of Hazardous Energy:

Required LOTO equipment1: List required isolation equipment (hasp, blanking plate, etc.).2: 3: 4:

Sequence for IsolationEnergy Source 1: Detail the sequence/steps for completing isolation;Energy Source 2: Energy Source 3: Energy Source 4:

Dissipating stored energyEnergy Source 1: Detail any information related to dissipating or controlling any stored or other energy;Energy Source 2: Energy Source 3: Energy Source 4:

WARNING: Test that the equipment has been effectively isolated by attempting to reactivate the plant, without exposing the tester or others to risk. If the equipment cannot be re-energised, energy isolation has been achieved and work may commence. Any associated work should have a completed risk assessment to ensure the control of any other related hazards and risks.

Re-energising the plant after the completion of workList the steps required to safely re-energise the machinery.1.2.3.4.5.6.

Authorised By: Signature: Date:

Isolation of Plant LOTO Template, v1 Responsible Officer: Manager, OH&S Page 2 of 2Date Effective: May 2020 Date of next review: April 2022

For the latest version of this document please go to: http://www.monash.edu.au/ohs/

2 – Identify Energy Source

3 – Identify Energy Source

1 – Identify Energy Source

Insert Photo and Information here: