Lock Out Tag Out

Date *

Time *

Location *

Specific Room Location (Corridor/Room #, etc.) *

Purpose of Lockout *

File Upload for Lockout Procedure

Drop your files here

Lockout Procedure ID

Lockout Placed by (First/Last Name) *

Trade/Contractor Initiating (Check all that apply) *

Energy Type(s) (Check all that apply) *

Tag/Lock # *

Voltage/Pressure

Systems/Occupancies Affected

Personal Phone # *

Estimated Lockout Duration *

Supervisor (First/Last Name) *

Occupant Notification Submitted (Yes/No) *

*

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