Operations and Maintenance Manual Universal Vacuum System
Version 1.2—March 2004 Page 13
LOCKOUT SAFETY PROCEDURE
(Reproduce for shop copy. Fill in data or check off as appropriate.)
EQUIPMENT LOCATION:
MODEL UVS SERIAL
NUMBER:
MANUFACTURER: STRASBAUGH
PROCEDURE AUTHORIZED
BY:
DATE:
PHONE:
DEPARTMENT:
OSHA regulations state, "The procedures shall clearly and specifically outline the scope, purpose,
authorization, rules and techniques to be used for the control of hazardous energy, and the means to
enforce compliance, including but not limited to the following:
• A specific statement of the intended use of the procedure.
• Specific procedural steps for shutting down, isolating, blocking and securing machines or equipment to
control hazardous energy.
• Specific procedural steps for the placement, removal and transfer of lockout devices or tagout devices
and the responsibility for them; and
• Specific requirements for testing a machine or equipment to determine and verify the effectiveness of
lockout devices, tagout devices, and other energy control measures."
SOURCES OF ENERGY FOR THIS EQUIPMENT: *
Electrical 120 VAC. _√_ Gas ___ Hydraulic ___
Electrical 208 VAC. ___ Chemical ___ Pneumatic _√_
Compressed Air _√_ Thermal ___ Other (specify) ___
STORED ENERGY (Remember, energy can be stored!) *
Raised Load ___ Air Tank _√_ Coiled Springs ___
Chemical ___ Charged Capacitors ___ Hydraulic Pressure ___
Battery ___ Pneumatic Pressure _√_ Other (specify) ___
* Note: Some checkmarks are provided—others may apply.
MACHINE MAINTENANCE MANUAL:
See the machine maintenance manual(s) before attempting any activities for which this procedure
applies. The maintenance manual(s) are usually the best single source of information vital to the
understanding of the machine and hazards which may be present.
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