HO-CHUNK NATION CODE (HCC)

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TITLE 6 – PERSONNEL, EMPLOYMENT AND LABOR CODE

SECTION 8 – OCCUPATIONAL SAFETY AND HEALTH

PROGRAM ACT OF 2002

SUBSECTION 5 – LOCK-OUT/TAG-OUT

ENACTED BY LEGISLATURE: MAY 20, 2002

LAST AMENDED AND RESTATED: December 6, 2022

CITE AS: 6 HCC § 8-5

1. Authority. See basic document (Occupational Safety and Health Program Act).

2. Purpose. This subsection of the Occupational Safety and Health Program Act provides for the

minimum requirements for lock-out and/or tag-out of energy isolating devices whenever maintenance

or servicing is done on machines or equipment. It is 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. This subsection applies to all work

operations within the Ho-Chunk Nation where employees must deal with lock-out/tag-out situations

as part of their job duties.

3. Definitions. See basic document (Occupational Safety and Health Program Act). In addition, the

following definitions apply to this subsection.

a. “Affected Employee” means 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.

b. “Authorized Employee” is an employee 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 subsection.

c. “Capable of Being Locked-Out” means an energy isolating device that 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.

d. “Energized” means connected to an energy source or containing residual or stored energy.

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e. “Energy Isolating Device” means 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.

f. “Energy Source” means any source of electrical, mechanical, hydraulic, pneumatic, chemical,

thermal, or other energy.

g. “Lockout” means 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.

h. “Lockout Device” means a device that utilizes a positive means such as a lock, either key or

combination type, to hold an energy isolating device in a safe position and prevent the energizing of

a machine or equipment. Included are blank flanges and bolted slip blinds.

i. “LOTO” means lock-out/tag-out.

j. “Tagout” means 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.

k. “Tagout Device” means 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.

l. “Zero Energy State” means a condition that is reached when all energy sources to or within

equipment is isolated, blocked, or otherwise relieved, with no possibility of re-accumulation.

Equipment is not safe to work on until it is a zero-energy state.

4. Training Requirements. The supervisor/manager shall provide training to ensure that the purpose

and function of the energy control program are understood by employees and the knowledge and

skills required for the safe application, usage, and removal of the energy controls are acquired by

employees. The training shall include the following:

a. Authorized Employees

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(1) Authorized employees shall receive training in the following:

(a) Recognition of the types of hazardous energy sources.

(b) Intended use of the lockout/tagout procedure.

(d) Steps for placement, removal, and transfer of lock-out/tag-out devices and the

associated responsibility.

(e) Requirements for testing to determine and verify the effectiveness of lock-out/tag-out

devices.

(f) Other appropriate measures necessary to protect employees from hazardous energy.

(2) A training roster/checklist has been provided at Figure A-2 for this level of training.

b. Affected Employees.

(1) All affected employees operating equipment, machines, or systems on which servicing and

maintenance is performed must receive initial lockout/tagout training which includes, but is not

limited to:

(a) Intended use of the lockout/tagout procedure.

(b) Steps for shutting down, neutralizing, isolating, holding and securing.

responsibility.

(d) Requirements for testing to determine and verify the effectiveness of lockout/tagout

devices.

(e) Other appropriate measures necessary to protect employees from hazardous energy.

NOTE: The extent of the training for affected employees can be less than that of authorized

employees, provided they understand the overall lockout/tagout procedure.

(2) A training roster/checklist has been provided in Figure A-3 for this level of training.

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c. Other Employees. Other employees entering work areas where servicing and maintenance is

performed must be trained concerning the purpose of the lockout/tagout procedure, and how to

recognize lockout/tagout jobs so they can avoid hazards to themselves and those performing the job

using lockout/tagout. A training roster/checklist has been provided in Figure A-3 for this level of

training.

NOTE: The training for other employees may be less than that for affected employees,

provided they understand the purpose of the procedure.

d. New or Transferred Employees. Each new or transferred employee (authorized, affected, and

others) shall be instructed in the purpose and use of the lockout/tagout procedure, as it pertains to

them, before they begin their initial assignment.

e. Employee Retraining. Retraining is required for all authorized and affected employees

whenever there is a change in job assignment, a change in machines, equipment or processes that

presents a new hazard, or when there is a change in the energy control procedure.

(1) Additional retraining shall also be conducted whenever a periodic inspection under Section

(8) reveals, or whenever the supervisor/manager has reason to believe that there are deviations from

or inadequacies in the employee’s knowledge or use of the energy control procedures.

(2) The retraining shall reestablish employee proficiency and introduce new or revised control

methods and procedures as necessary.

5. Exclusions. LOTO procedures do not apply under the following conditions:

a. Minor tool changes and adjustments, and other minor servicing activities that take place during

normal operations if they are routine, repetitive, and integral to the use of the equipment, provided

that the work is performed using alternative measures that provide effective protection.

b. Work on cord and plug connected electrical equipment for which exposure to the hazards of

unexpected energization or start up of the equipment is controlled by the unplugging of the

equipment from the energy source, and the plug remains under the exclusive control of the employee

performing the servicing, maintenance, or modification.

c. Electrical systems less than 50 volts to ground that do not increase exposure to electrical burns

or to explosion due to electrical arcs.

6. Responsibilities.

a. All Employees.

(1) Understand the general reasons for LOTO.

(2) Recognize when LOTO is being used.

(3) Understand the importance of not tampering with or removing a lock and/or tag.

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b. Authorized Employees.

(1) Attend LOTO training.

(2) Recognize the conditions of work that require LOTO.

(3) Use the materials and procedures specified to implement the LOTO program.

c. Managers and Supervisors.

(1) Attend LOTO training.

(2) Provide authorization for employees, and maintain records of authorized employees.

(3) Ensure that authorized employees have attended LOTO training. Provide additional on-thejob training if the employee is not thoroughly familiar with the equipment and/or written procedures.

(4) Provide required LOTO equipment to employees, and ensure that they use it.

(5) Control emergency keys for LOTO locks.

(6) Remove LOTO devices in case of emergency.

(7) Generate and maintain equipment-specific written procedures, where required, and identify

the equipment.

(8) Maintain records of LOTO events.

7. Lockout/Tagout Equipment. Each facility/department shall supply, and employees shall use,

lockout/tagout devices and equipment necessary to execute the requirements of Section 8. Locks and

tags used for control of exposure to electrical hazards shall be unique, shall be readily identifiable as

lockout/tagout devices, and shall be used for no other purpose.

a. Padlocks. Padlocks shall be identified as being used for LOTO. Each padlock shall be identified

with the authorized employee’s name and department. A supervisor/manager may elect to utilize a

checkout system that permits authorized employees to borrow locks from a common local supply. In

such cases, the authorized employee checking out a lock must label it with his/her name.

b. Keys. Each LOTO padlock is required to have two keys, primary and emergency. The primary

key must be in the possession of the authorized employee who applied the lock. The emergency key

must be kept in a secured area (e.g., a lock box) with access limited to the authorized employee’s

immediate supervisor/manager and one level of management above the authorized employee’s

manager. A group of locks with a common key may be used for equipment with multiple energyisolation devices, if desired. If a group of locks is keyed alike for this purpose, one key only may be

issued for use by the authorized employee and a second key may be kept for emergency use.

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c. Tags. Tags must clearly identify the employee who applies them. Tags must also warn against

hazardous conditions if the machine or equipment is energized and must include a legend such as any

of the following: DO NOT START, DO NOT OPEN, DO NOT CLOSE, DO NOT ENERGIZE, DO

NOT OPERATE.

d. Tag Means of Attachment. Each tag means of attachment must be non-reusable, attachable by

hand, self-locking and non-releasable, with a minimum unlocking strength of no less than 50 pounds.

The device for attaching the tag also must have the general design and basic characteristics

equivalent to a one-piece nylon cable tie that will withstand all environments and conditions.

e. Other Hardware. The supervisor/manager shall provide other hardware as required such as

multiple lock hasps and circuit breaker and valve lockout devices.

8. Lockout/Tagout Procedures.

a. General Requirements.

(1) All employees performing servicing and maintenance on equipment, machines, and systems

must be protected by following LOTO procedures. See Figure A-5.

(2) Specific individual procedures are required for all servicing and maintenance of equipment,

machines or systems requiring LOTO of more than one energy source. See Figure A-6.

(3) Specific LOTO procedures are not required to be documented if all the following criteria

exist:

(a) Equipment, machines, or systems have no potential for stored or residual energy or

reaccumulation of stored energy after shut down which could endanger employees;

(b) Equipment has a single energy source, which can be readily identified and isolated;

deactivate the machine or equipment;

(d) The machine or equipment is isolated from the energy source and locked out during

servicing or maintenance;

(e) A single lock-out device will achieve a locked-out condition;

(f) The lockout device is under the exclusive control of the authorized employee performing

the servicing or maintenance;

(g) The servicing or maintenance does not create hazards for others; and

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(h) The facility or department, in utilizing this exception, has had no accidents involving the

unexpected activation or re-energization of the machine or equipment during servicing or

maintenance.

b. Specific Individual Lockout/Tagout Procedures. Each department is required to prepare specific

individual LOTO procedures for all equipment, machines and systems requiring more than one

lockout/tagout of those that do not meet the exception requirements listed in paragraph a, above.

Each department is required to prepare specific individual lockout/tagout of energy isolating devices

and/or those that do not meet the exception. Each department’s LOTO procedure shall clearly and

specifically outline the scope, purpose, authorization, rules, and techniques to be utilized for the

control of hazardous energy, and the means to enforce compliance including, but not limited to, the

following:

(1) A specific statement of the intended use of the procedure;

(2) Specific procedural steps for shutting down, isolating, blocking, and securing machines or

equipment to control hazardous energy;

(3) Specific procedural steps for the placement, removal and transfer of lockout devices or

tagout devices and the responsibility for them; and

(4) Specific requirements for testing a machine or equipment to determine and verify the

effectiveness of lockout devices, tagout devices, and other energy control measures.

c. Shift or Personnel Changes. To ensure the continuity of LOTO protection during shift or

personnel changes where work is to be continued by an oncoming shift, an orderly transfer of LOTO

devices between authorized employees from the off-going and oncoming shift must be performed.

The authorized employees from both shifts must both be present at the lockout device. The off-going

authorized employee must remove his/her lock and tag, and the oncoming authorized employee must

immediately place his/her lock and tag on the LOTO device. The authorized off-going employee

must inform the authorized oncoming employee of any potential hazards.

d. Annual LOTO Procedure Review. Each LOTO procedure must be annually reviewed by an

authorized employee, other than the one utilizing the energy control procedure. The review will be

documented (Figure A-1) and kept on file in the affected department. This will be accomplished by

the authorized employee observing a LOTO job and recording the following information.

(1) Inspector’s name (authorized employee performing the review).

(2) Location.

(3) Time and date.

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(4) LOTO job (procedure observed).

(5) Employees involved.

(6) Inspection findings.

(7) Any deviations or inadequacies observed.

(8) Recommendations.

(9) Corrective action taken.

e. Procedure. The sequence for LOTO is as follows:

(1) Notify all affected employees that a lockout or tagout system is going to be utilized and the

reason for its use. The authorized employees shall know the type and magnitude of energy that the

machine or equipment utilizes and shall understand the hazards of the energy to be controlled, and

the method or means to control the energy.

(2) If the machine or equipment is operating, shut it down by the normal stopping procedures.

An orderly shutdown must be utilized to avoid any additional or increased hazard(s) to employees as

a result of the equipment stoppage.

(3) Operate the switch, valve, or other energy isolating device(s) so that the equipment is

isolated from its energy source(s). Stored energy (such as that in springs, elevated machine members,

rotating flywheels, hydraulic systems, and air, gas, steam, or water pressure, etc.) must be dissipated

or restrained by methods such as repositioning, blocking, bleeding down, etc.

(4) Each individual involved must lockout and/or tagout the energy isolating devices with

assigned and approved individual lock(s) or tag(s). A multiple LOTO device is one, which allows

many authorized employees to lockout/tagout a single energy source.

(5) After ensuring that no personnel are exposed, and as a check for having disconnected the

energy sources, operate the normal operating controls to make certain the equipment will not operate.

Caution: Return operating control(s) to neutral or off position after the test.

(6) The equipment is now locked out or tagged out and the authorized employee(s) can perform

the servicing and maintenance.

(7) After the servicing and/or maintenance is complete and equipment is ready for normal

operations, check the area around the machines or equipment to ensure that no one is exposed to

hazards relating to start-up.

(8) After all tools have been removed from the machine or equipment, guards have been

reinstalled and employees are in the clear, remove all lockout or tagout devices. Operate the energy

isolating devices to restore energy to the machine or equipment.

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f. Testing or Positioning or Machines, Equipment, or Components. In some cases, it may be

necessary for authorized employees to briefly remove their lockout/tagout devices for testing or

positioning machines, equipment, or components. Before removing the lockout/tagout devices, the

authorized employee clears the machine/equipment and removes potentially exposed employees.

Once the machine/equipment is clear, remove the lockout/tagout devices only for a time required to

perform the controlled testing or positioning ensuring that no one is, nor will be, exposed to injury.

Energize the machine/equipment and proceed with the testing/positioning. Immediately following the

testing/positioning, de-energize the machine/equipment and reapply the lockout/tagout device(s).

g. Tag-out Only.

(1) If a device is incapable of being locked out, a “tagout only” procedure may be employed.

Any energy-isolating device capable of being locked out must be locked out without exception.

(2) To conduct a tagout only procedure, the authorized employee must follow all the steps

outlined in paragraph a, above. The placement of the lock is omitted. Instead, the authorized

employee must utilize a second means of isolating the hazardous energy. Removal of an isolating

circuit element, the blocking of a controlling switch, the opening of an extra disconnect device, or the

removal of a valve handle are all examples of secondary measures. The second means of isolation

must be identified on the tag, and tags must be affixed to both the energy isolating device, and at the

point of the second means of isolation.

(3) If it is determined that a device is incapable of being locked out and a second means of

isolation is not possible, then an equipment-specific written procedure is required to be written prior

to implementing the procedure. See paragraph 9.

h. Emergency Removal of LOTO Devices. When the authorized employee who applied a LOTO

device is not available to remove it, the manager may remove the device, provided that specific

procedures and training for such removal have been developed, documented and incorporated into

the LOTO program. The supervisor/manager shall demonstrate that the specific procedure provides

equivalent safety to the removal of the device by the authorized employee who applied it. This is

considered to be an emergency procedure, to be undertaken only in extreme circumstances. Extreme

care must be taken and the following steps must be performed:

(1) The supervisor/manager must verify that the authorized employee is not at the facility. If

the employee’s location cannot be determined, no further action shall be taken.

(2) The supervisor/manager must make every reasonable effort to contact the authorized

employee. This may include a telephone call to the employee’s home or other location.

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(3) If the employee is contacted, the supervisor/manager must inform the employee that his/her

LOTO devices are being removed.

(4) The supervisor/manager must verify that it is safe to remove the LOTO devices.

(5) The supervisor/manager may then use the emergency key to remove the LOTO devices, or

the lock may be cut off if the key is not available.

(6) The supervisor/manager must ensure that the authorized employee is presented with the

removed lock immediately upon returning to work and is informed of the reasons for the emergency

removal.

(7) The emergency procedure must be duly recorded in the department’s LOTO records and

signed by both the supervisor/manager and the authorized employee.

9. Equipment Specific Written Procedures. An equipment specific written procedure is required if

the equipment undergoing servicing, modification, or maintenance has more than one energy source;

requires the operation of more than one device to isolate the hazardous energy; has potential for

stored, residual, or accumulated hazardous energy; is incapable of being locked out, and a second

means of isolation is not possible.

a. Preparing an Equipment Specific Written Procedure.

(1) A written energy control procedure must be generated by the department, group, or

authorized employee most familiar with the equipment. This procedure must be used by any

authorized employee who will perform LOTO on the equipment. Supervisors/managers must ensure

that equipment that requires a written procedure is so identified, and that the procedure is readily

available to the employees authorized to perform LOTO on the equipment.

(2) Any equipment with an equipment specific written LOTO procedure must be clearly

labeled as such. The supervisor/manager or employee responsible for the equipment may determine

the appropriate format and content of the label, for example:

CAUTION—An equipment-specific written procedure exists for the locking and tagging of

this equipment. This equipment-specific written procedure may be obtained from _________.

b. Elements of an Equipment Specific Written Procedure.

(1) The equipment specific written procedure must incorporate each step in paragraph 8a.

(2) It is essential that the specific application of each LOTO step be clearly explained in the

context of the specific equipment.

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10. Recordkeeping Requirements.

a. Each LOTO event must be fully documented in the department log, project log, or a dedicated

LOTO logbook.

b. The following information must be documented:

(1) Name of authorized employee who performed LOTO.

(2) Date and time LOTO was applied.

(3) Equipment and circuit identification.

(4) Reason for LOTO.

(5) Schematic drawing or print numbers, when available.

(6) Date and time of LOTO removal.

(7) Name of authorized employee who removed LOTO if different from authorized employee

who initiated LOTO.

c. At the discretion of the supervisor/manager, recordkeeping requirements may be satisfied by

an orderly system of archiving completed tags.

d. Records shall be maintained for two years.

11. Administration and Enforcement. See Section 12 of the Occupational Safety and Health

Program Act.

Forms:

Figure A-1 Lock-out/Tag-out Evaluation

Figure A-2 Lock-out/Tag-out Training for Authorized Employees

Figure A-3 Lock-out/Tag-out Training for Affected and Other Employees

Figure A-4 Lock-out/Tag-out Energy Isolating Device Survey

Figure A-5 General Lock-out/Tag-out Procedure

Figure A-6 Lock-out/Tag-out Procedures for Multiple Energy Sources

_________________________________________________________________________________

Legislative History:

12/5/01 Reviewed by Administration Committee.

1/9/02 Legislature posts for 45-day Public Review.

5/20/02 Enacted as Lockout/Tagout (6 HCC § 8-5) by Legislative Resolution 5/20/02E.

9/29/22 Legislature posts for 45-day Public Review.

12/6/22 Enacted as Lockout/Tagout (6 HCC § 8-5) by Legislative Resolution 12-06-22E.

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Figure A-1

Lock-out/Tag-out Evaluation

THE HO-CHUNK NATION

LOCKOUT/TAGOUT EVALUATION

Date:

Department:

Location:

Lockout/Tagout Evaluation Scope:

Each Ho-Chunk Nation department/enterprise is responsible for evaluating all of their equipment, machines, and

systems, which may require servicing and maintenance, and to identify potentially hazardous energy sources,

which require lockout/tagout. This form may be used to assist in the evaluation. The information obtained from

this evaluation will be the basis for preparing appropriate LOTO procedures and training employees.

EVALUATION

Item No.

Hazardous

Energy

Type

Hazardous

Energy

Magnitude

Description of Equipment,

Machines, or Systems

Specific

Location

Comments

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Figure A-2

Lock-out/Tag-out Training for Authorized Employees

HO-CHUNK NATION

LOCK-OUT/TAG-OUT TRAINING FOR AUTHORIZED EMPLOYEES

Dept: _________________________ Trainer: _____________________ Date: ______________________

Authorized Employee Training

Lock-out/tag-out training for AUTHORIZED employees includes special instructions concerning scope,

purpose, authorization, rules, and techniques for lock-out/tag-out of hazardous energy sources including,

but not limited to:

_____ Intended use of the procedure;

_____ Steps for shutting down, isolating, holding, and securing;

_____ Steps for placement, removal and transfer of lockout/tagout devices and the responsibility, and

_____ Requirements for testing to determine and verify effectiveness of lock-out/tag-out devices and

_____ Other measures

Trainees:

EMPLOYEE NAME

JOB TITLE

DEPARTMENT

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Figure A-3

Lock-out/Tag-out Training for Affected and Other Employees

HO-CHUNK NATION

LOCK-OUT/TAG-OUT TRAINING FOR AFFECTED and OTHER EMPLOYEES

Dept: ______________________________ Trainer: ____________________________________ Date:

______________________

Affected and Other Employee Training

Lock-out/tag-out training for AFFECTED and OTHER employees includes special instructions concerning

scope, purpose, authorization, rules, and techniques for lockout/tagout of hazardous energy sources

including, but not limited to:

_____ Intended use of the procedure;

_____ Steps for shutting down, isolating, holding, and securing;

_____ Steps for placement, removal and transfer of lock-out/tag-out devices and the responsibility, and

_____ Requirements for testing to determine and verify effectiveness of lock-out/tag-out devices and

_____ Other measures

Trainees:

EMPLOYEE NAME

JOB TITLE

DEPARTMENT

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Figure A-4

Lock-out/Tag-out Energy Isolating Device Survey

Lock-out/Tag-out Energy Isolating Device Survey HO-CHUNK NATION

LOCK-OUT/TAG-OUT ENERGY ISOLATING DEVICE SURVEY

Date: ________________ Department: _________________________________ Location:

______________________________

Facility: ______________________________________________

Lockout/Tagout Survey

Each department will survey their department and identify those energy isolating devices for

use in locking/tagging equipment, machines, and systems. Such energy isolating devices may

include, but are not limited to: Electrical disconnect switches, hydraulic valves, pneumatic

valves, chemical valves, and other energy isolating means. This information, along with the

types of energy, will be used to prepare the required procedures.

Survey

Item No.

Describe

Equipment,

Machine or

Systems

Hazardous

Energy

Isolating

Devices

Description

Isolating

Devices

Identity

Comments

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Figure A-5

General Lock-out/Tag-out Procedure

Dept.

Facility

HO-CHUNK NATION

GENERAL LOCK-OUT/TAG-OUT PROCEDURE

Location

Scope

This procedure covers the necessary safety precautions and procedures for servicing and maintenance of machines and equipment in

which the unexpected energization or start up, or release of stored energy could cause injury to employees.

Purpose

This procedure covers the minimum requirements for lock-out and/or tag-out of energy isolating devices to protect employees from

hazardous energy including electrical, mechanical, hydraulic, pneumatic, or other energy. It will be used as a general procedure for

isolating all potentially hazardous energy (lock-out/tag-out) before employees perform any servicing and maintenance activities where

unexpected energization, start up, or release of stored energy could cause injury. This procedure, when used in conjunction with the

specific information concerning individual machines, provides the necessary information for lock-out/tag-out of machines with the

multiple energy sources.

Procedure

Only trained, authorized employees can lock-out/tag-out. All affected and other employees working in or entering work areas where

lock-out/tag-out is performed must be trained concerning lock-out/tag-out procedures. Determine all energy isolating devices

requiring lock-out/tag-out to ensure effective control of hazardous energy. Determine the type and magnitude of the energy and

required controls. Notify all affected employees of the plans to lock-out/tag-out. Shutdown the equipment/process by proper

procedures. Locate the necessary energy isolating device(s) for the equipment/process and operate them to isolate energy sources and

affix lockout/tagout devices. Relieve all stored or residual energy and take appropriate measures to ensure energy does not

reaccumulate. Affix lock-out/tag-out device as necessary. Verify energy isolation and relief of stored energy after ensuring employees

are not exposed and before beginning work. After start buttons are activated, press the stop button. Perform the servicing and

maintenance. To safely restore machines, equipment or processes to normal production operations, replace all guards and safety

devices remove all personnel, remove all tools and equipment. Notify affected employees. Remove lock-out/tag-out devices (by

authorized employee(s) installing lock-out/tag-out devices).

Lock-out/Tag-out Device Removal by Employer

When it becomes necessary to remove the lock-out/tag-out device of an employee who is unavailable at the facility, it can be done

only by the supervisor/manager and then under a special, approved procedure.

Group Lock-out/Tag-out

When a lock-out/tag-out job involves numerous lockout/tagout devices and many employees, a group lock-out/tag-out procedure may

be used. A separate, special written procedure or permit is required.

Contractors

All contractors must comply with the lock-out/tag-out procedures specified by the site supervisor/manager and employees of the HoChunk Nation must not violate the contractor’s lock-out/tag-out.

Procedure Reviewed By

Date

Procedure Authorized By

Date

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Figure A-6

Lock-out/Tag-out Procedures for Multiple Energy Sources

HO-CHUNK NATION

LOCK-OUT/TAG-OUT PROCEDURES FOR

MULTIPLE ENERGY SOURCES

Date: _____________________________ Procedure No. ___________________________

Department: ______________________________________ Facility:

______________________________________________

Location: ______________________________________________________________

Purpose

This lockout/tagout procedure for multiple energy sources is for use in protecting employees performing servicing and

maintenance of machines and equipment in which the unexpected energization or start up, or release of stored energy could

cause injury to employees. It is specifically designed for use with the general lock-out/tag-out procedure.

Procedure

Department

Equipment/Machine/Process

Description of Job

Item No.

Type

Required Lock-out/Tag-out Devices (Locks, tags, chains, etc.)

Magnitude

Description

Number

Energy Isolation

Step

Isolation Device

Identity

Location

LOTO Device

Comments

Isolated

Stored/Residual Energy

Comments

Job Performed by: _____________________________________________ Date: __________________________

LOTO Procedure Authorized/Approved by: _____________________________________________________________

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