Implementation Guidelines

Transcription

1 UAW-GM Lockout Energy Control Program Implementation Guidelines Inventory Code: LK102BK

2 Materials prepared by the UAW-GM Center for Human Resources Health and Safety Department No material in this book may be copied, reproduced, or used in any way without written permission. Revised 2008 Copyright 2005 UAW-GM Center for Human Resources All Rights Reserved Inventory Code: LK102BK

3 Table of Contents Implementation Guidelines Scope and Application... 3 Policy... 4 Roles and Responsibilities... 5 Lockout-Energy Control Program... 6 Procedure Annual Review of Placards Employee Training... 8 Inspections Audits...11 Hazard Awareness...11 Tasks Covered by These Guidelines Minor Servicing Tasks Bus Plug Installation Energy Isolating Devices Monitored Power Systems

4 UAW-GM Lockout Energy Control Requirements for Lockout Devices Personal Safety Locks When Lockout-Energy Control Cannot Be Performed Removal of Safety Locks Work Continuation on Multiple Shifts Procedure Involving More Than One Person Outside Personnel (Contractors, Etc.) Glossary Appendices A GMNA Common Lockout-Energy Control Procedure Inadequate Lockout Form Lockout-Energy Control Application Inspection Form

5 Scope and Application Implementation Guidelines This booklet provides guidelines for the implementation of the UAW-GM Lockout-Energy Control Program. The guidelines are intended to cover all tasks that expose employees to potential injury from energy sources during maintenance or servicing activities. To provide adequate protection for all employees, the UAW and GM have agreed to NOTE: THE UAW AND GM COLLECTIVE BARGAINING AGREEMENT DOES NOT RECOGNIZE THE USE OF TAGOUT PROCEDURES FOR HAZARDOUS ENERGY CONTROL. THE ONLY ACCEPTED USE OF A TAG IS FOR IDENTIFICATION PUPOSES WHEN USED IN CONJUNCTION WITH AN APPROVED LOCK. THEREFORE, ALL FURTHER DISCUSSION IN THIS BOOKLET WILL REFER ONLY TO LOCKOUT. 3

6 UAW-GM Lockout Energy Control Policy During the current negotiations the UAW and GM discussed their mutual concern regarding fatalities and serious injuries to employees performing service and maintenance activities on machinery and equipment. The parties agreed that to be effective, the UAW- GM Lockout-Energy Control Program must be universally implemented and enforced injury from energy is critical to worker safety. It is the policy of General Motors and endorsed by the UAW that: Lockout is required where employees may be exposed to hazardous energy which could cause injury. Exposures means that the employee is in a position to be injured by released energy. Where an employee is exposed to potential injury from expected machine energy, the exposure must be eliminated. If the exposure cannot be eliminated, the machine will be locked out. GM commits that each location will maintain an effective Lockout-Energy Control Program which will apply to all employees. The UAW agrees to support this policy and encourage its members to utilize lockout-energy control. It is the employees right and responsibility to receive required training, to follow established local procedures, and to seek the counsel of local leadership in the event of a situation which the employee believes may violate this policy. 4

7 Roles and Responsibilities Implementation Guidelines It is the responsibility of management to direct and oversee implementation of the Lockout- Energy Control Program utilizing the specialized skills and experience of engineering, skilled trades, maintenance and health and safety individuals as needed. The Plant Safety Review Board will monitor the implementation of this program. The Plant Safety Review Board shall: Review, on a regular basis, with the Local Joint Health and Safety Committee the implementation of this Lockout Energy Control program. Commit adequate resources so that all elements of this program are implemented. Identify a competent management person to assist with technical issues and implementation. The Local Joint Health and Safety Committee shall: priority action. Provide technical assistance. Audit the annual inspection of the Lockout-Energy Control Program. this program to be used for heightening the awareness of all appropriate employees. Monitor the development (using the jointly designated tool) and installation of placards to ensure they are consistent with the guidelines included in this document. Provide summary reports to local leadership, as appropriate, to monitor the effectiveness of this program. All of the above are appropriate subjects for discussion at the Divisional Review Boards. 5

8 UAW-GM Lockout Energy Control Lockout-Energy Control Program Each facility is required to establish a lockout energy control program to include the following three elements: Documented energy control procedures Employee training Periodic inspections Procedure A Lockout-Energy Control Procedure is included in Appendix A for reference in developing machine, are necessary to supplement the local Lockout-Energy Control Procedure. Where and posted for that operation. The UAW-GM Lockout-Energy Control Program requires that an energy control procedure be developed, documented and used to control energy sources whenever employees are exposed. The written procedure will contain the information that authorized employees must know in order to control energy during service or maintenance. The energy control procedure must outline the scope, purpose, authorization, rules and techniques that will be used to control energy sources as well as the means that will be used to enforce compliance. The lockout-energy control procedure must include the following elements: A statement that explains how the procedure will be used. The lockout procedure needed to shut down, isolate, block, and secure machines or equipment. The steps designating the safe placement, removal and transfer of lockout devices as well as the person responsible for them. the effectiveness of locks and other energy control measures. The local lockout procedure must include the following steps: 6

9 Implementation Guidelines 1. Prepare for shutdown: A. Inform affected employees, B. Identify energy sources, C. Determine if exposure exists and lockout is needed, and D. Follow posted placard. 2. Shut down the machine or equipment. 3. Isolate the machine or equipment from the energy source. 5. Safely release all potentially hazardous stored or residual energy. 6. Verify the isolation of the machine or equipment as outlined by the posted placard prior to the start of servicing or maintenance work. Before lockout devices are removed and energy is restored to the machines or equipment, certain steps must be taken to re-energize equipment after servicing is completed. These steps include: 1. Inspecting the work area to ensure that non-essential items have been removed and that machine or equipment components are intact and capable of operating properly. 2. Checking the area around the machine or equipment to ensure that all employees have been safely positioned or removed. 3. Notify the affected person immediately after removing locks and before starting equipment or machines. only by those workers who attached them. In instances when the lock cannot be removed by the authorized person, the device may be removed under management direction according to a predetermined procedure outlined 7

10 UAW-GM Lockout Energy Control A placard will be placed on equipment with multiple energy sources or a single energy source machine where isolating devices might not be readily apparent to an authorized employee. Placards are designed to assist authorized personnel with identifying the types of energy, means of verifying deactivation of energy sources, and exposure to special conditions which might affect the control of energy. Information on such placards will be consistent with the guidelines jointly developed. Equipment with Monitored Power Systems will (in addition to Lockout Placards) have an be generated by performing a risk assessment,using the risk assessment software. In addition, the g-plac tool will be used to create a corporate wide common approach when creating lockout placards for new machines and equipment. The g-plac tool will also be used to update existing placards into the common placard template whenever machinery Annual Review of Placards MPS task placards and lockout placards shall be reviewed annually to ensure the placards are representative of the procedure required to lock out the equipment and all the lockout reviewed and deemed satisfactory be labeled as such. A round sticker in the bottom corner the PSRB to ensure appropriate compliance. supplemental procedure will be developed. Employee Training Authorized Person Authorized Person Initial Training Plant management must provide effective initial training and retraining as necessary. All authorized persons and their supervisors must be trained in the recognition and control of energy sources using the UAW-GM Lockout Energy Control training. As part of this training, the employee must demonstrate knowledge of the elements of the procedure, the include the name of the employee and the date of the training. 8

11 Implementation Guidelines Newly hired employees will receive lockout-energy control training prior to performing any assignments involving lockout-energy control. Supplemental (Retraining) Authorized persons will receive appropriate supplemental training whenever there is a change in the local procedure or whenever new hazards are presented as result of a change in job assignments, a change in machine, equipment, or processes with which they may not be familiar. Training will also be provided on the proper use of monitored power systems when equipment enters the facility with the MPS feature. Additional supplemental training must be conducted whenever a periodic inspection reveals, or whenever there is reason to believe, that there are deviations from or training must include one or more of the following: tasks that were covered in previous training. Awareness/Refresher The local Lockout-Energy Control Program must be reviewed at least annually with all authorized persons. This annual review will focus on improving hazard awareness for employees who utilize lockout and energy control. Materials provided by the UAW-GM Center for Human Resources Health and Safety Department will be used. The development of additional local material and delivery of this review will be coordinated by the Local Joint Health and Safety Committee and should include: Reports of Lockout related incidents and injuries to improve hazard awareness Review of the Lockout-Energy Control Program Inspection summary Review of fatalities and process changes Monitored Power Systems, if applicable 9

12 UAW-GM Lockout Energy Control Employee Training Affected Person Employee Training All affected persons must be instructed on the general provisions of the Lockout-Energy Control Program. Small group meetings can be utilized to provide this instruction to all affected employees. The National Joint Committee will oversee the development of this training. Documentation Documentation of all Lockout-Energy Control training, enforcement activities, periodic inspections, and annual reviews will be audited by the Local Joint Health and Safety Committee. Inspections An inspection must be conducted annually to ensure that all provisions of the Lockout- Energy Control Program are being followed. The primary responsibility for inspection falls within the scope of the management designated employee, such as a General Supervisor, Supervisor, or other competent employees. Members of the Local Joint Health and Safety Management. The criteria for establishing inspections follows. Inspections may use a representative random sample based on a statistical process that considers all authorized persons, machines and processes. Inspections must also include interviews by supervisors, as part of the periodic inspection, to assess employees knowledge of policies and procedures. The interviews must be documented. Inspection will be based on: The required task Proper use of energy-isolating devices, when required Proper application of locks by each authorized person, when required 10

13 Implementation Guidelines An inspection form is included in Appendix C which can be used as a model for plant inspections. performing any further tasks. Audits The audit module developed by the UAW-GM Center for Human Resources Health and Safety Department must be utilized by the Local Joint Health and Safety Committee to document compliance. The Local Joint Health and Safety Committee must monitor actions needed to correct discrepancies. be used as a basis for formal discipline. Hazard Awareness Hazard Awareness is important to a successful Lockout-Energy Control Program. Increased attention must focus on having all employees follow safe operating practices and maintaining a safe position when power is required or intended to be on. Information to focus attention on energy control is included in all UAW-GM Lockout training. In addition, UAW and GM recognize that continuing research is needed for developing a practical approach to assist plants in proactively determining hazards, improving lockout capability on equipment, and to develop new technologies for controlling hazardous energy. The National Joint Committee will oversee these efforts. The intent of the research will be Examples of situations that may create exposure are described below. When existing safeguarding devices that prevent exposure are rendered ineffective. For example: removing a guard or bypassing an interlocking device. During minor adjustments to machines or equipment. For example: adjustment of parts-locating devices, limit switches, or other parts-presence devices. While unjamming equipment or relocating mislocated parts. For example: placing a panel on gauge in a press or automated equipment. 11

14 UAW-GM Lockout Energy Control Tasks Covered by These Guidelines Controlling energy when exposure exists is key to protecting employees. Lockout of the energy source is the preferred method of energy control; however, certain tasks cannot be performed without power on. Such activities must be performed without exposure to hazards created by the energy source through the utilization of the other methods. If exposure occurs, lockout must be performed or the exposure eliminated through safe operating procedures such as work methods, repositioning, safeguarding devices, or personnel protective equipment. For Example see Appendix B During a servicing activity-such as lubricating, cleaning, or unjamming, the employees performing the servicing may be subjected to hazards that are not encountered as part of the normal production operation itself. Employees engaged in these operations are covered by the UAW-GM Lockout-Energy Control Implementation Guidelines if they are exposed to Minor Service Tasks Lockout is generally not required under the following situations: While servicing or maintaining cord and plug-connected electrical equipment. In these cases, hazards must be controlled by unplugging the equipment from the energy source. The plug must be under the exclusive control of the worker who is When workers are performing tasks that do not expose them to the release or start up of energy. A task which involves equipment energized at a voltage less than 50 volts AC or DC where there will be no increased exposure to electrical burns or to explosion due to electric arcs. no exposure. When making adjustments no exposure occurs. 12

15 Bus Plug Installation Implementation Guidelines During recent negotiations, the UAW and GM discussed their mutual concern regarding the inherent hazards associated with live bus plug installation. The practice of installing and removing bus plugs from energized bus ways will be discontinued. All bus plug-in units There may be cases where events or conditions create a greater hazard or it is infeasible to de-energize the bus way. If such cases arise, the guidelines that are included in the UAW-GM Electrical Safe Work Practices Document (Section 6 Planning Electrical Work and Section 11 Bus Plug-in Units and Bus Ways) will be followed. Moreover, safety policies and training procedures for workers must be developed to address safety access to switch houses, substations, and bus duct up procedures. Management will classify testing and maintenance of breakers in switch houses and substations as high risk jobs. 13

16 UAW-GM Lockout Energy Control Energy Isolating Devices An energy-isolating device is a mechanical device which prevents the transmission or release of energy from a given source to the machine or equipment, (e.g., electrical disconnects, pneumatic and hydraulic valves, manually operated switches, etc.). When locked out, the energy isolating device guards against accidental machine or equipment start up or the unexpected re-energization of equipment during servicing or maintenance. In addition to energy isolating devices, other methods that may be used for hazardous energy control include: Removing and isolating a circuit element Blocking a hydraulic line Monitored Power Systems In recent years, Monitored Power Systems (MPS) have been integrated into many of our facilities with great success. Using MPS allows an authorized employee to enter a safeguarded area without locking out individual energy isolating devices. The focal point is the MPS gate box. MPS removes all potential hazardous motion within the work area and allows the worker to restart the system from a single point (i.e., MPS gate box). However, it is understood by the parties that the MPS feature can only be used if the task involved accepted risk assessment process. All tasks that have not been predetermined through a TaBRA and noted on the MPS task placard shall be locked out according to the lockout 14

17 Implementation Guidelines Requirements for Lockout Devices When attached to an energy-isolating device, lockout devices (locks and scissors, i.e., lockout adapters) are tools that can be used in accordance with the requirements of the by holding an energy-isolating device in the safe position, thus preventing the machine or equipment from becoming energized. These devices are to be: Durable Lockout devices must withstand the environment to which they are exposed for the maximum duration of the expected exposure. Standardized Lockout devices must be standardized according to either color, shape or size. Substantial Lockout devices must be substantial enough to minimize accidental removal. Locks must be substantial enough to prevent removal, except by excessive force of special tools, such as bolt cutters or other metal-cutting tools. Locks must clearly identify the employee who applies them (i.e., employee photo A captive key system may be used to eliminate the need for authorized persons to carry a large number of locks. In a captive key system, the key(s) from the lock(s) attached to the energy isolating device(s) is(are) secured in a designated box or container which allows individuals to apply their personal lock(s). Personal Safety Locks are acceptable for lockout energy control. Each GMNA facility will provide authorized employees common safety locks to be used for energy control in accordance with this program. The common locks will be lightweight, high visibility green and will have the 15

18 UAW-GM Lockout Energy Control When Lockout-Energy Control Cannot Be Performed If assigned to perform a task where exposure exists and lockout-energy control cannot be performed, the employee should immediately contact supervision for assistance in performing the job safely. In this case, either: or 1. The employee may be given supplemental retraining or instruction as outlined on 2. If it is determined that the machine design is such that an inadequate lockout form member of management and instruction provided before the employee performs the task. Inadequate Lockout Form and send it to the Engineering Department. A determination must be made (by Engineering and supervision) whether or not the task or If this can be accomplished, the modifcations should be made prior to work being started. gather knowledgeable personnel (e.g., skilled trades, engineers, Local Joint Health and Safety Committee [LJHSC], production personnel, etc.) in order to develop a draft lockout the Plant Safety Administrator prior to the task being conducted. 16

19 Implementation Guidelines available in the facility, the following steps are necessary. The supervisor remains the responsible party for the development of the draft If not approved, power lockout MUST be performed prior to conducting work. If approved, the task may be completed on a one-time basis, after the temporary the task. next page). could be involved in the task in the future. the task may be conducted in the future. 17

20 UAW-GM Lockout Energy Control 18

21 Implementation Guidelines New equipment and machinery should be designed to safeguard employees performing service and maintenance activities as well as production operators. Equipment should be designed to ensure that routine tasks such as adjustments, lubrication, and other minor servicing duties can be performed outside of the hazard area to avoid exposure. on a priority basis. In such instances, maintenance and engineering will be immediately be forwarded to engineering and its implementation monitored by the Local Joint Health and Safety Committee. Where necessary, parts will be ordered and installed when they following criteria: Permit maintenance, servicing, and trouble shooting without employee(s) entering the danger zone. Energy isolating devices should be designed to de-energize machinery and allow for maintenance of control circuits for diagnostics and quick recovery to productive operation. Energy isolation methods and devices must provide for required tasks. They also must allow for the maintenance of energy that may be necessary to perform the intended tasks. Required energy isolating devices should be designed and arranged for the convenience of use. Meet the provisions of the most current version of the jointly agreed to Design for Health and Safety standards. 19

22 UAW-GM Lockout Energy Control Removal of Safety Locks assigned owner of a safety lock may remove the safety lock from an energy-isolating absence of the employee shall be established locally. Work Continuation in Multiple Shifts procedure. Procedure Involving More Than One Person In the preceding steps, if more than one employee is required to lockout equipment, each shall place their own personal lockout device on the energy isolating device(s). When an energy-isolating device cannot accept multiple locks, a multiple lockout device may be used. A single lock or set of locks may be used to lockout the machine or equipment with the key(s) being placed in a lockout box or cabinet. As each employee no longer needs to maintain their lockout protection, that employee will remove their lock from the box or cabinet. Outside Personnel (Contractors, etc.) item for the National Joint Committee on Health and Safety. 20

23 Glossary Implementation Guidelines Affected person A person who performs the duties of their job in an area where the lockout-energy control procedure is implemented and service or maintenance operations are performed. An affected person does not service or maintain machines or equipment and consequently is not responsible for implementing the lockoutenergy control procedure. An affected person becomes authorized whenever they perform maintenance functions on machines or equipment that must be locked out. Affected persons could include engineers and supervisors. Authorized person A person who performs service or maintenance on machines and equipment. Lockout is used by these persons for their protection. This includes nonskilled trades workers performing tasks such as unjamming parts on equipment. Capable of being locked out An energy-isolating device is considered capable of being locked out if it meets one of the following requirements: It is designed with a hasp to which a lock can be attached. It has a locking mechanism built into it. It can be locked without being dismantled, rebuilt, replacing the energy isolating device, or permanently altering its energy control capability. Competent person A management-designated person who has the knowledge and skills have completed the UAW-GM Lockout-Energy Control training. Energized Machines and equipment are energized when (1), they are connected to an energy source, or (2), they contain residual or stored energy. Energy-isolated device Any mechanical device that physically prevents the transmission or release of energy. They include, but are not limited to, manually-operated include push buttons and selector switches. Energy source Any source of electrical, mechanical, hydraulic, pneumatic, chemical, thermal, or other energy. Energy control procedure A written document that contains those items of information an authorized person needs to know in order to safely control energy during service or maintenance of machines or equipment. 21

24 UAW-GM Lockout Energy Control Energy control program A program intended to prevent the energizing or the release of stored energy in machines or equipment that could cause injury. The program consists of energy control procedure(s), an employee training program, and periodic inspections. Exposure Exposure means that the employee is in a position to be injured by released energy. Hazardous Energy Energy which could cause injury to the servicing employee if it was serviced. Lockout Any placement of a lockout device on an energy-isolating device, in accordance with an established procedure, ensuring that the energy-isolating device and the equipment being controlled cannot be operated until the lockout device is removed. Lockout device Any device that uses positive means, such as a lock, to ensure an energy-isolating device in a safe position, thereby preventing the energizing of are considered equivalent to lockout devices. Neutralize To make ineffective. Normal production operations The utilization of a machine or equipment to perform its intended production functions. Servicing and/or maintenance Workplace activities such as constructing, installing, or equipment, and making adjustments or tool changes. Safe Operating Procedure is determined that the machine design is such that a particular task cannot be done following the plant Lockout Energy Control procedure as posted. Setting up Any work performed to prepare a machine or equipment to perform its normal production operation 22

25 Implementation Guidelines Appendix A GMNA (General Motors North America) Common Lockout-Energy Control Procedure This procedure is intended to serve as a model for GM plants. It covers all of the criteria for procedures outlined on page 9 and is only one part of an overall Lockout-Energy Control Program. This must be supplemented by a placard for equipment with multiple energy sources or equipment where a single energy isolating device is not readily apparent. Lockout Procedure for (Name of Facility) Purpose This procedure establishes the minimum requirements for the lockout of energy isolating devices whenever maintenance or serving is done on machines or equipment. It shall be used to ensure that the machine or equipment is stopped and isolated from all potentially hazardous energy sources (electrical, hydraulic, pneumatic, etc.) and locked out before employees perform any servicing or maintenance where the unexpected energization or start up of the machine or equipment or the release of stored energy could cause injury. Responsibility will be conducted to instruct employees of methods and procedures in the de-energizing and safe work practices for equipment. Each new or transferred employee, and other employees who may be in the area, shall be instructed in the purpose and use of the lockout procedure. Sequence of Lockout (1) Notify all affected employees that servicing or maintenance is required on a machine or equipment and that the machine or equipment must be shut down and locked out to perform the servicing or maintenance. (2) Authorized employees shall refer to the company procedure to identify the type and magnitude of the energy that the machine or equipment utilizes, shall understand the hazards of the energy and shall know the methods to control the energy. (3) If the machine or equipment is operating, shut it down by the normal stopping procedure (depress the stop button, open switch, close valve, etc.) 23

26 UAW-GM Lockout Energy Control isolated from the energy source(s). (5) Lockout the energy isolated device(s) with the appropriate safety lock(s). (6) Stored or residual energy (such as that in capacitors, springs, elevated machine pressure, etc.) must be dissipated or restrained by methods such as grounding, repositioning, blocking, bleeding down, etc. checking that no personnel are exposed, then verify the isolation of the equipment by operating control(s) or by testing to make certain the equipment will not operate. CAUTION: Return operating control(s) to neutral or off position after verifying the isolation of the equipment. Restoring Equipment to Service When the servicing or maintenance is completed and the machine or equipment is ready to return to normal operating condition, the following steps shall be taken: Check the machine or equipment and the immediate area around the machine to ensure that nonessential items have been removed and that the machine or equipment components are operationally intact. Check the work area to ensure that all employees have been safely positioned or removed from the area. Verify that the controls are in neutral. Remove the lockout devices and re-energize the machine or equipment. NOTE: The removal of some forms of blocking may require re-energization of the machine before safe removal. Notify affected employees that the servicing or maintenance is completed and the machine or equipment is ready for use. 24

27 Implementation Guidelines Appendix B Example 1 Employee receives a maintenance work order, Parts not locating properly, Station #1, Operation # 10. Employee goes to job: Removes guard and observes transfer and part location in action from safe position transferred Locks out energy source for transfer and follows all the steps in the lockout-energy control procedure be performed Lock is removed Machine placed in manual and jogged into position Places machine in automatic and observes from a safe position 25

28 UAW-GM Lockout Energy Control Example 2 One hour later, employee receives maintenance work order for same machine, Parts not locating on station #4, Operation #10. Employee observes job while machine is in automatic Employee places machine in manual- jogs machine- uses feeler stock to check part in location alignment with indexing Employee determines machine designed such that the head can only index when transfer power is on Employee stops work and consults with supervisor For interim safe practice, hydraulic line to transfer bar is disconnected and capped allowing the head to index in manual position without the transfer power to be on line to transfer Inadequate Lockout Form processed Machine placed in manual and jogged into position Employee places machine in automatic and observes from a safe position exposure 26

29 Implementation Guidelines UAW-GM Lockout Energy Control Inadequate Lockout Form Machine/Equipment Name: Location: Building Floor Bay Column Energy Source: Supervisor: Lockout Energy Control Problem: Floor Recommendations to Safely Perform Tasks: Reviewed and Approved by: UAW Health and Safety Rep: Safety Supervisor: Name: Date: Name: Date: Name: Date: Engineering Contact Person: Name: Phone: Date Received: Correction Date: 27

30 UAW-GM Lockout Energy Control UAW-GM Lockout Energy Control Lockout-Energy Control Application Inspection Form Page One Department: Machine Number: Equipment: Task location: Authorized Person(s) Name(s): Training: Yes No Yes No Yes No Affected Person(s) Name(s): Training: Yes No Yes No Yes No No If so, by whom? Name(s) of supervisor(s): 28

31 Implementation Guidelines Lockout-Energy Control Application Inspection Form Page Two 1. Is a written Lockout Procedure available: Yes No If yes, state its location: 2. Is the Lockout Procedure being followed: Yes No If no, state elements not being followed: 3. Is the procedure posted? Yes No No 5. Is the procedure adequate? Yes No 6. Has lockout been performed by all involved persons? Yes No 8. Name all energy sources that create hazards for a task: be locked out? Yes No b. Was the Inadequate Lockout-Energy Control form completed? Yes Not Required 29

32 UAW-GM Lockout Energy Control Lockout-Energy Control Application Inspection Form Page Three 10. Did each authorized person lock all required energy sources? Yes No a. If no, list correction below. 11. Did each authorized person verify lockout? Yes No a. If not, list corrective action below. THIS FORM MUST BE RETAINED BY THE INSPECTOR AND LOCAL JOINT HEALTH AND SAFETY COMMITTEE FOR A PERIOD OF TWO YEARS FROM THE DATE OF COMPLETION. 30

33 Implementation Guidelines Notes 31

34 UAW-GM Lockout Energy Control Notes 32