Loading...
Adopt Lockout Tag-Out Policy as Section 4.610 of Risk Management and Safety Policy of LC Employee Handbook BEFORE THE BOARD OF COUNTY COMMISSIONERS LEWIS COUNTY, WASHINGTON IN THE MATTER OF: RESOLUTION NO. 21-097 ADOPT THE LOCKOUT TAG-OUT POLICY AS SECTION 4.610 OF THE RISK MANAGEMENT AND SAFETY POLICY OF THE LEWIS COUNTY EMPLOYEE HANDBOOK WHEREAS, the Lewis County Board of County Commissioners (BOCC) passed Resolution 18-099 on March 12, 2018, to approve the Lewis County Employee Handbook; and WHEREAS, Lewis County is committed to maintaining a safe work environment; and WHEREAS, it appears to be in the best interest of Lewis County to adopt the Lockout Tag-Out Policy. NOW THEREFORE BE IT RESOLVED that the Board of County Commissioners adopt the Lockout Tag-Out Policy as Section 4.610 of the Risk Management and Safety Policy of the Lewis County Employee Handbook. DONE IN OPEN SESSION this 16th day of March, 2021. APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS Jonathan Meyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON Amber Smith Gary Stamper By: Amber Smith, Gary Stamper, Chair Deputy Prosecuting Attorney ATTEST: .•'<' '"•t>• Lindsey R. Pollock, DVM •`�S.00d)OF' !J•. L tdse R. Pollock, DVM, Vice Chair .4, Y giNCS •;s6(1,71 S. J. Rieva Lester •• '�'��• � Sean D. Swope Rieva Lester, Sean D. Swope, Commissioner Clerk of the Lewis County Board of County Commissioners Page 1 of 1 Res. 21-097 Supersedes: Effective Date:May 1,2021 Lockout-Tag-Out Lockout-Tag-Out Po�ic'S°' POLICY 4.610 Statutory Authority: Policy OSHA/WAC 296-or45- 17505/RCW49.17.010 Policy Lewis County (LC)has established the following written program for the utilization of procedures for affixing appropriate lockout devices or tags to disable machines or equipment before any servicing or maintenance is performed where the unexpected energizing, start up,or release of stored energy could occur and cause injury to employees. This program consists of energy control procedures,employee training and periodic inspections. The program refers to two categories of employees which are defined below: Affected Employee: An employee whose job requires him or her to operate or use a machine or equipment on which service,maintenance or repair is being performed under Lockout-Tag-Out (LOTO),or whose job requires him or her to work in an area in which such servicing, maintenance, or repair are being performed. Authorized Employee: A person who has been certified to perform LOTO on machines or equipment in order to perform service, maintenance,or repair. LC will provide: locks,tags,chains,wedges,key blocks,adapter pins, self-locking fasteners, or other hardware for isolating, securing,or blocking of machines or equipment from energy sources. The LOTO Program provides for a safe method of working on, near, or in machinery or equipment that can cause serious injury. This program shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing or maintenance where the unexpected energization or start-up of the machine or equipment,or release of stored energy,could cause injury. Compliance with This Program It is the responsibility of each employee: (1) To comply with the restrictions and limitations imposed upon them during the use of lockout. (2) To perform the lockout in accordance with this procedure;and (3) Upon observing a machine or piece of equipment which is locked out for servicing or maintenance to not attempt to start,energize,or use that machine or equipment. Any employee who does not follow this lockout/tagout program may be subject to disciplinary action found in the LC Employees Handbook and in accordance with current collective bargaining agreements. Such action will be considered a serious safety violation. (4) In the event that a particular assignment makes it impractical to follow all the provisions of this program, the supervisor directing the work activities will be notified immediately and before work starts. Safety&Risk Management Policy 4.610 Plug and Cord Connected Equipment Before any work or maintenance is performed on plug-and-cord connected equipment,either portable or fixed,employees will unplug the equipment from its power source(This includes blade change out on any power saw),or, lockout the power source. If you are unable to maintain control of,or are out of sight of,the plug before maintenance is complete,attach a lockout or tag to the plug. Interlocks Interlocks will not be relied on for safety or to meet the requirements for lockout. The equipment or machinery must be locked out individually. 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. (2) For the machines or equipment (which have more than one source of energy requiring lockout), refer to the attached machine/equipment-specific procedures found in in the LC LOTO Operations Manual (Appendix A) for the specific procedures to be followed for locking-out the machine or equipment. (3) If the machine or equipment is operating, shut it down by the normal stopping procedure (depress stop/off button,open switch,close valve,etc.). (4) De-activate the energy isolating device(s) (main switch, circuit breaker, flow/control valve, etc.)so that the machine or equipment is isolated from the energy source. (5) Lockout the energy isolating device(s) with assigned individual lock(s) and attach Tag(s), (stating reason for the lock out condition). If more than one person is exposed to the hazard or is working on the machine or equipment,each person must attach their individual lock. Only the person who attaches the lock is authorized to remove their lock. (6) Dissipate or restrain any stored or residual energy(such as that in capacitors,springs,elevated machine member, rotating flywheels, hydraulic systems, and air, gas, steam or water pressure, etc.) by such actions as grounding,repositioning,blocking,bleeding down,etc. (7) Ensure that the machine or equipment is disconnected from the energy source(s) by first checking that no persons are exposed,then verify the machine or equipment is isolated by operating the push/on button or other normal operating control(s) or by testing to make certain the machine or equipment will not operate. Return operating controls to neutral or off position after verifying the isolation of the machine or equipment. For y electrical work, voltage checks will be made of any circuit elements and electrical parts on which work is to be performed and any exposed adjacent parts. (8) The machine or equipment is now locked out,and servicing or maintenance may proceed. Restoring the Machine or Equipment to Service Safety&Risk Management Policy 4.610 When the servicing or maintenance is complete and the machine or equipment is ready to return to normal operating condition,the following steps shall be taken. To restore energy: (1) Check the machine, make sure nonessential items are removed from the machine, all components are operationally intact,and all guards are installed. (2) Clear the work area and notify all affected employees that the lockout/tagout is going to be removed. (3) Verify that the controls are in the neutral position. (4) Remove the lockout/tagout device and reenergize the equipment. Except in emergencies, only the person who attached the lockout device may remove it! Contact must be attempted by the acting supervisor, if contact is not made documentation by two on site employees must occur. See Appendix C,removal of another person's device. (5) Notify affected employees that servicing or maintenance is complete and the machine is ready for use. Training LOTO training will be conducted for all employees who are required to perform work on any equipment as referenced in this program once every three years. The training will address all components and procedures of this program. It will include methods to ensure employees understand the purpose and function of the program,that they can recognize applicable lockout/tagout situations, and that they have acquired the knowledge and skills required for applying, using, and removing the locks and tags. Assessment Each machine/equipment-specific lockout procedure must be assessed at least annually to ensure that the procedure remains valid or if any changes are warranted. This assessment must be machine- procedure specific and be documented by department supervision. Safety&Risk Management Policy 4.610 LEWIS COUNTY RISK & SAFETY DEPARTMENT LEWIS COUNTY/ -11114:1Wr LOCKOUT-TAG-OUT PROGRAM MANUAL Risk&Safety Department 1 351 NW North Street I Chehalis,WA 98532 (360)740-2737 I https://lewiscountywa.gov/risk Reviewed and Revised January 13, 2021 pg. 1 of 17 Status Contacts Implementation Comments Date pg.2 of 17 Introductio Employees can be seriously or fatally injured if machinery they service or maintain unexpectedly energizes,starts up, or releases stored energy. OSHA's standard on the Control of Hazardous Energy (Lockout-Tag-Out), found in Title 29 of the Code of Federal Regulations (CFR) Part 1910.147, and Washington State WAC 296-803-100 spells out the steps employers must take to prevent accidents associated with hazardous energy. The standard addresses practices and procedures necessary to disable machinery and prevent the release of potentially hazardous energy while maintenance or servicing activities are performed. Lockout-Tag-Out(LOTO)equipment is used to prevent unexpected energization of machinery,and also helps to alert employees that maintenance activities are in progress. Equipment is considered"locked out"when potential energy is blocked and operation of machinery is prevented until the device is removed. When equipment is "tagged out",a warning tag will be used to signal that the equipment is not to be used or operated.These combined safety measures will be used to ensure maximum protection. ADMINISTRATIVE RESPONSIBILITIES ENVIRONMENTAL HEALTH AND SAFETY The specific responsibility for developing and implementing safety & risk programs for Lewis County (LC) Employees resides with the Risk and Safety Department (R&S). In fulfillment of this responsibility, R&S has prepared the LC LOTO Program and assists other departments in the development and implementation of LOTO procedures for their areas. DEPARTMENTS Each department is responsible for evaluating areas under its administrative control and determining whether there are processes or equipment that have the need for LOTO procedures. Departments who find the need for LOTO are responsible for the adoption and implementation of the contents of this LOTO Manual and are also responsible for providing the necessary training, understanding and equipment to their employees. In addition, each department must develop and maintain current equipment-specific LOTO procedures applicable to their operations. MANAGERS AND SUPERVISORS Managers and Supervisors play a key role in the implementation of the LOTO Program.They are responsible for: determining situations that require the presence of LOTO devices and procedures;ensuring that all personnel are properly trained in LOTO procedures; identifying which personnel are required to participate in the LOTO program; ensuring proper LOTO devices are available to personnel; and ensuring that provisions of the program are followed. PERSONNEL Personnel are responsible for observing all practices and procedures contained in the LOTO Program, understanding the proper procedures for energy control, other general safety practices, attending designated training sessions,and reporting hazardous or unsafe conditions to their supervisor,or R&S. pg.3of17 PROGRAM REVIEW R&S will review the LOTO Program annually. Recordkeeping from the previous year will be used to determine if revisions are needed. If revisions are needed,the changes shall be made and employees trained on the revisions. STANDARD OPERATING PROCEDURES Standard operating procedures (SOP) describe the method(s) that will be used to complete a task or operation. Departments with the need for LOTO procedures must develop SOPs and incorporate them into this manual to complete their LOTO Program. Equipment-Specific Procedures must be developed by departments for the items outlined below to make the program specific to their areas. • Training authorized and affected employees. • Identify potentially hazardous energy associated with equipment,the energy source and the means of isolating that energy from equipment or machinery. • Develop and review specific LOTO procedures for all machinery and equipment that will require a specific LOTO procedure. • Utilizing the proper procedures for the restoration of equipment to power after service and maintenance has been performed. • Establish steps indicating the safe removal and transfer of LOTO devices and who will be responsible for these steps. • Ensure all outside contractors comply with the LOTO standard and provide specific lockout procedures to ensure an understanding of energy sources and energy isolatingdevices. • Periodically review LOTO program to ensure accuracy and compliance. EXEMPTIONS Work on cord and plug connected equipment for which exposure to the hazards of unexpected energizing or start- up of the equipment is controlled by the unplugging of the equipment from the energy source and the plug being under the exclusive control of the employee performing the servicing or maintenance will be excluded from this procedure. "Live work"operations involving transmission and distribution systems for substances such as gas,steam,water, or petroleum products when they are performed on pressurized pipelines will be excluded from the procedure provided that: • Continuity of service is essential • Shutdown of the system is impractical • Documentation procedures are followed and special equipment is used which will provide proven protection for employees • Operations involving electrical distribution equipment Electronic testing, diagnostic testing, and adjustments that do not place an employee in a point of operation will be excluded from this procedure. • pg.4 of 17 'raining All employees who are anticipated to be involved in working with energy systems are required to complete training on LOTO procedures. Department Management will provide training to ensure that the purpose and function of the energy control program is understood by employees and that the knowledge and skills required for the safe application, usage and removal of the energy controls are acquired by employees. This training will help employees to recognize applicable hazardous energy sources, the type and magnitude of the energy in the workplace, and the methods for energy isolation and control. Additionally,retraining shall be provided for all employees whenever there is a change in job assignments,change in machines,when a new hazard is presented or when there is a change in energy control procedures. Retraining shall also be conducted when the employer has a reason to believe that there are deviations from or inadequacies in the employee's knowledge or use of the energy control procedures. Affected and Authorized employees are required to be trained on energy control procedures (LOTO), Authorized employees are expected to have a thorough understanding of procedures involved with ensuring"Zero Energy State"which is a point at which the equipment has been safely isolated from any chances of re-energization or release of internal contained energy. An optional review form has been included to assist with reviewing employees who are to be Authorized employees. The review/audit form is located in Appendix E: of this manual. LOTO Procedures and Devices LOTO procedures must be practiced any time there is the potential for unexpected energization or start-up of machinery or equipment, or the release of hazardous energy during service or maintenance activities. LOTO procedures are also required when work requires any faculty, staff or student to place any part of their body in a potential danger zone. LOTO equipment consists of locks, chains, tags, hasps and other hardware used to prevent the operation of equipment which is being serviced or maintained. Lockout devices are to be used whenever possible to control potential energy by keeping equipment in an "off"position. Tags should be used in conjunction with lockout devices to warn against operation. POTENTIAL ENERGY SOURCES Sources can include: • Electrical • Pneumatic • Hydraulic • Water • Gas • Chemical or Coolant • Steam • Mechanical pg.5 of 17 Regardless of the energy source type or the LOTO device used, all LOTO devices must meet the following minimum criteria: • Must be of durable construction and capable of withstanding the conditions in which they are placed. • Must be identified as such and must only be used for the control of hazardous energy sources. • Must identify the individual applying the device. • Must not be bypassed, ignored or otherwise defeated • Should be standardized by department, in color; size; shape and format. • Should only be removed by the authorized employee originally attaching them. Removal by anyone else must be performed by the guidelines in section F: Removal of LOTO Devices. USE OF TAGS Tags may only be used,alone,when equipment cannot physically accept a lockout device. In these cases,all other procedures consistent with the LOTO Program must be followed. The tags must be affixed as closely as possible to the isolation devices, immediately obvious to anyone attempting to restart the equipment. Additional control measures must be taken to reinforce the tagout device. Tags must be legible and understandable by all employees and must contain warnings against energizing the equipment, such as; DO NOT START, DO NOT OPEN, DO NOT CLOSE, DO NOT ENERGIZE, DO NOT OPERATE. Tags must be in plain view, at the same location as the energy isolation devices and must be securely attached to prevent accidental removal. PREPARING EQUIPMENT FOR LOTO Before service and/or maintenance activities begin, the following procedures must be implemented in order, when locking or tagging out equipment: 1. Prepare for shutdown; • Evaluate the equipment and identify all potential energy sources and the means for controlling them. Follow Appendix C for equipment-specific LOTO procedures. • Notify all affected employees in the work area when performing LOTO procedures. 2. Shut down the machine; • Equipment will be shut down using the normal shut-down procedures. When equipment is properly shut down, attach a"DANGER, DO NOT OPERATE"tag to the powerswitch. 3. Disconnect or isolate the machine from the energy source(s); • The equipment will then be de-energized and isolated from any hazardous energy sources. 4. Apply the LOTO device(s) to the energy isolating device(s); • The Authorized employee will then affix the needed locks/tags to the appropriate energy isolating locations. 5. Release, restrain or otherwise render safe all potential hazardous stored or residual energy. If a possibility exists for re-accumulation of hazardous energy, regularly verify during the service and maintenance that such energy has not re-accumulated to hazardous levels;and • Release all pressure lines such as gas, air, steam, and hydraulic. pg.6 of 17 • Blocking mechanical equipment with moving,rotating or elevated parts. • Releasing spring loaded equipment. 6. Verify the isolation and de-energization of the machine. • Before maintenance,verify that the machine is de-energized by first establishing that no personnel are exposed and attempt to turn the machine on using normal operating controls. GROUP LOTO Group lockout should be performed when work is being done on equipment by more than one individual. Each department should develop a process for group LOTO procedures. This information should be outlined in Appendix C: Energy Control Procedure. Group LOTO can use a lockout device that accepts multiple locks,or a group box that stores all keys and is only opened by one competent individual.A group representative should be selected to supervise the LOTO procedure. He or she will be responsible for maintaining the group lockout box, or affixing the group lockout device.The representative will also oversee the entire LOTO operation and monitor the process to ensure it is performed in accordance with applicable regulatory requirements. SHIFT CHANGES At times, equipment maintenance will extend beyond one work shift, so a procedure must be in place to transfer control of LOTO procedures and equipment to the arriving shift. This is done by allowing the arriving employee to apply his/her LOTO devices prior to the outgoing employee removing their devices. The responsibility for this occurring in a seamless fashion is held by all departing and arriving shift supervisors involved with the project.These supervisors will be required to oversee the transfer of LOTO devices and ensure that energy control is maintained throughout the transfer. WORKING WITH CONTRACTORS When outside servicing personnel are to be engaged in activities regarding LOTO,the onsite vendor will follow LC's LOTO Operations Manual or their Company's Policy/Procedures whichever is more stringent in management. TESTING EQUIPMENT If an employee must re-energize equipment during service/maintenance and it requires the temporary removal of the LOTO device(s),they must follow this sequence: 1. Clear all tools and materials from equipment/machinery; 2. Remove all employees from equipment area; 3. Remove LOTO devices; 4. Energize and proceed with service/maintenance; 5. De-energize and reapply LOTO devices. pg.7 of 17 Removal of LOTO Devices Each LOTO device must be removed from each energy isolating device by the employee who applied it. Removal of the device will be accomplished by following the steps below: 1. Ensure that the equipment is operational and all tools are removed and safe guards are put back in place. 2. Ensure all employees are clear of the equipment. 3. Employee who placed the LOTO device will remove the LOTO device. 4. Re-energize equipment. 5. Notify surrounding employees that servicing/maintenance has been completed and machine is ready for use. REMOVAL OF ANOTHER PERSON'S LOTO DEVICE When the authorized employee who applied the LOTO device is not available to remove it, the device may be removed under the direction of the supervisor,provided they can demonstrate that the specific procedure of dev ice removal provides the same degree of safety as removal by the authorized employee who applied it.This procedure must include the following elements: 1. Verify the authorized employee is not at the facility. 2. Notify the employee's supervisor of the situation. 3. Ensure that all efforts are made to inform the authorized employee that his/her LOTO device must be removed. 4. If the authorized employee is unable to return to work, the department manager(or designee) may use bolt cutters to remove the lock. 5. Ensure the authorized employee has knowledge of the removal before they return to work at the facility. 6. All such actions must be recorded on Appendix C: LOTO Removal Form. pg.8 of 17 Directory of Services Risk Department 351 NW North Street Chehalis WA 98532/(360) 740-2737 Lewis County Safety 351 NW North Street Chehalis WA 98532/(360) 740-1157 Facilities Management 542 NW Center Street/(360) 740-1192 Fleet Services 476 West Main Street/(360) 740-1191 Central Shop 109 Forest Napavine Road/(360) 740-1150 pg.9of17 LAI ppendix A: Definitions LIST OF TERMS Affected employee:An employee whose job requires him/her to operate or use a machine or equipment on which servicing or maintenance is being performed under lockout or tagout, or whose job requires him/her to work in an area in which such servicing or maintenance is being performed. Authorized employee: A person who locks out or tags out machines or equipment in order to perform servicing or maintenance on that machine or equipment.An affected employee becomes an authorized employee when that employee's duties include performing servicing or maintenance covered under this section AND they have been trained to do so, safely. Capable of being locked out: An energy isolating device is capable of being locked out if it has a hasp or other means of attachment to which, or through which, a lock can be affixed, or it has a locking mechanism built into it. Other energy isolating devices are capable of being locked out, if lockout can be achieved without the need to dismantle,rebuild,or replace the energy isolating device or permanently alter its energy control capability. Energized: Connected to an energy source or containing residual or stored energy. Energy isolating device: A mechanical device that physically prevents the transmission or release of energy, including but not limited to the following: A manually operated electrical circuit breaker; a disconnect switch; a manually operated switch by which the conductors of a circuit can be disconnected from all ungrounded supply conductors, and, in addition,no pole can be operated independently;a line valve; a block; and any similar device used to block or isolate energy. Push buttons, selector switches and other control circuit type devices are not energy isolating devices. Energy source: Any source of electrical, mechanical,hydraulic,pneumatic,chemical,thermal,or other energy. Live Work: A procedure used in the repair, maintenance and services activities which involves welding on a piece of equipment(pipelines, vessels or tanks) under pressure, in order to install connections or appurtenances. It is commonly used to replace or add sections of pipeline without the interruption of service for air, gas, water, steam,and petrochemical distribution systems. Lockout: The 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. pg. 10 of 17 Lockout device: A device that utilizes a positive means such as a lock, either key or combination type, to hold an energy isolating device in the safe position and prevent the energizing of a machine or equipment. Included are blank flanges and bolted slip blinds. Normal production operations: 'l he utilization of a machine or equipment to perform its intended production function. Servicing and/or maintenance: Workplace activities such as constructing, installing, setting up, adjusting, inspecting, modifying, and maintaining and/or servicing machines or equipment. These activities include lubrication,cleaning or unjamming of machines or equipment and making adjustments or tool changes,where the employee may be exposed to the unexpected energization or startup of the equipment or release of hazardous energy. Setting up: Any work performed to prepare a machine or equipment to perform its normal production operation. Tagout: The placement of a tagout device on an energy isolating device, in accordance with an established procedure, to indicate that the energy isolating device and the equipment being controlled may not be operated until the tagout device is removed. Tagout device: A prominent warning device, such as a tag and a means of attachment, which can be securely fastened to an energy isolating device in accordance with an established procedure, to indicate that the energy isolating device and the equipment being controlled may not be operated until the tagout device is removed. pg.11 of 17 !Appendix B: Energy Control Procedures A LEWIS COUNTY ENERGY CONTROL PROCEDURE Equipment ID: Mfg.: Model ID No: No: Equipment Location(s): Date Performed: Task(s)to be Performed: Name of Person Performing Assessment: A. ENERGY FORM(S):(Check all that apply) ❑ 1. Electrical ❑ 5.Mechanical—Capable of crushing,pinching,cutting,snagging, striking. ❑ a.Low Voltage(50-600V) ❑ b.High Voltage(>600V) 0 6.Thermal—High Temperature,surface temperature,Hot Liquids, steam ❑ 2.Chemical/Explosion—Pressure, extreme heat, ❑ 7.Thermal—Cryogenic—contact with super cold surface or with fire,corrosive,reactive,oxidizer,toxic. cryogenic liquid. ❑ 3. Pressure ❑ 8. Stored—Flywheels,springs,differences in elevation,elevated parts ❑ Pneumatic that could drop,capacitors,batteries. ❑ Hydraulic ❑ 4. Vacuum B.BASIC PROCEDURES Lockout Procedure: Procedure to Device to Operation: ❑ I.Notify all affected personnel ofLOTO. ❑ 10.Verify Danger Zone is clear of equipment,workers, ❑ 2.Turn off power at disconnect points listed in Column C.1. tools,and test equipment. ❑ 3.LOTO each energy control point listed in ColumnC.l. ❑ 1 1.Unlock and remove any blocking devices;remove linkages. ❑ 4.Dissipate/disconnect any stored energy.See Column ❑ 12.Reposition any safety devices. C.2. {0 N/A) ❑ 13. Wam workers to stay clear of area. ❑ 5.Block any mechanical parts,remove any mechanical links.Lock blocking in place. ❑ 14.Remove all locks and tags from energy control {ON/A}(NOTE:Two physical blocks required to secure points. any gas/liquid line). ❑ 15. Verify area is clear of personnel. ❑ 6.Verify personnel are clear of hazards. ❑ 16.Re-start/re-energize the equipment ❑ 7. Verify no hazardous energy remains. Use circuit ❑ 17.Notify all affected personnel and other persons that the tester/meter if electrical energy is involved. See Column lockout has been cleared. C.4. ❑ 8.Attempt to re-start machinery or re-energize equipment through normal means. NOTE:Return switch back to OFF position. ❑ 9. Perform required work. C.SPECIFIC PROCEDURES Hazardous Energy C.1 Specific Lockout C.2 Dissipate Stored C.3 BlockThcse Parts/Remove C.4 Verify Locations Energy At These Linkages Residual Energy (Specify form&Values Points By These including names of chemicals) Methods pg.12 of 17 Appendix C Removal o f Another Person's Devic } The following steps will be followed when removal of another person's lock and/or tag is necessary.This is to be completed by the Manager that authorizes removal of the lock and/or tag and witnessed by another Supervisor/Manager. 1: Attempt to contact the person to have him/her remove his/her lock(s)and/or tag(s). Employee's Name: Facility/Dept.: What attempt was made?(Phone,etc.): Result of contact? Date: Time 2: Notify the affected people. Check the area to ensure it is clear and safe before removing the LOTO device(s). Lock ID Number(s)that was destroyed (cut off)? Person(s) involved in checking the area and removing the LOTO device(s)were: 3: The individual's Supervisor will discuss this serious matter with the employee before returning to work the following shift. Who held the discussion with the employee? Provide details and/or your comments: Employee's Signature: Date: Witnessing Supervisor: Date: 4: Retain this document for departmental safety records. pg. 13 of 17 Appendix D: Periodic Inspection This form is used to audit energy control procedures for the following equipment/machine(s): Basic Information: Complete/Compare with Existing Energy Control Procedure Department: Building: Date: Location/Area: Inspector: Authorized Employee(s)Involved: Other Employee(s)Affected: Service/Maintenance Activities Requiring LOTO: Review the current LOTO Procedures and indicate whether they are satisfactory. Any procedures marked "No'. must have a detailed explanation under Comments/Deficiencies, below. A. Control Methods: Satisfactory? ❑Yes ❑No B. General Review of Responsibilities and Procedures: Satisfactory? ❑Yes ❑No C. Energy Identification: Satisfactory? ❑Yes ❑No D. Lockout Device: Satisfactory? ❑Yes ❑No E. Energy Release Methods: Satisfactory? ❑Yes ❑No F. Lockout Steps: Satisfactory? ❑Yes ❑No G. Comments/Deficiencies: pg. 14 of 17 Certification: This energy control procedure is adequate (or modified as noted above). The inspector has reviewed appropriate responsibilities with the Authorized Employee(s). Tag limitations were inspected and appropriate affected employees included in this review where tagout devices are used. Inspector's Signature: Date: Authorized Employee's Signature: Date: Authorized Employee's Signature: Date: Authorized Employee's Signature: Date: pg. 15 of 17 Appendix E: Authorized Employee Review/Audit Employee Name: Employee #: Department: Supervisor: Date of Most Recent LOTO Training: When conducting the annual review with the authorized employee, you must ask the employee to answer the questions listed below. If the employee can fully answer the question, check the "Yes" box. If the employee cannot fully answer the question,check the"No"box and conduct additional training to ensure that the employee understands. 1. When must the LOTO Procedure be utilized? ❑ Yes. Fully understands ❑ No. Does not fully understand 2. What should be done if you must leave your lock in place I i Yes. Fully understands after the end of your shift? No. Does not fully understand 3. What should be done if more than one person is working ❑ Yes. Fully understands with/or on a piece of equipment which must be locked out? I I No. Does not fully understand 4. How many keys are allowed for each lock? ❑ Yes. Fully understands ❑ No. Does not fully understand 5. Who is allowed to remove a lock? Yes. Fully understands No. Does not fully understand 6. What does the phrase,"one lock,one key,one person" I I Yes. Fully understands mean? No. Does not fully understand pg. 16 of 17 Select a piece of equipment with multiple power sources. Have the employee lockout the equipment utilizing the approved energy control procedure. If the employee is unable to successfully achieve a zero energy state, conduct additional training to ensure that the employee fully understands the procedures. Equipment Selected: Power Source: Did the employee notify affected personnel& others as required? I I Yes No Did the employee successfully identify all sources of energy and their magnitude? Yes I I No Did the employee successfully relieve, block, or isolate all sources of stored energy? I j Yes n No Did the employee apply lockout devices to the energy isolating devices properly? Yes No Did the employee test lockout and return controls to"neutral"or"off'position? Yes No Did the employee successfully achieve a"zero energy"state? I I Yes No Did the employee notify affected personnel prior to returning equipment to service? I Yes No Did the employee ensure the equipment was prepared to be returned to service? n Yes ❑ No Supervisor's Name Supervisor's Signature pg.17 of 17 BOCC AGENDA ITEM SUMMARY Resolution: BOCC Meeting Date: March 16, 2021 Suggested Wording for Agenda Item: Agenda Type: Deliberation Adopt the Lockout Tag-Out Policy as Section 4.610 of the Risk Management and Safety Policy of the Lewis County Employee Handbook Contact: Andy Caldwell Phone: 3607401157 Department: DES - Emergency Management (Dept. of Emergency Services) Description: Adopt the Lockout Tag-Out Policy as Section 4.610 of the Risk Management and Safety Policy of the Lewis County Employee Handbook Approvals: Publication Requirements: Publications: User Status Josh Metcalf Pending PA's Office Pending Additional Copies: Cover Letter To: Matt Patana Tim Murphy Josh Metcalf