PSU LOTO Program

Issue Date: August 20, 2010

Appendix B
Penn State University
EXAMPLE ONLY - Equipment-Specific LOTO Procedure Development Form- EXAMPLE ONLY

SECTION I: GENERAL INFORMATION

Date Prepared: 6/26/2010 Preparer Information
Campus: Erie Name: John Smith
Work Unit: Engineering Job Title: Maintenance Technician
Building Name: Skytop
Equipment Covered by Procedure: Compressor
Location of Equipment: Room 214
SECTION II: SEQUENCE OF LOTO STEPS
Step 1: Identify All Energy Sources
Energy Source Type & Location of Isolation Device Control Method
Electric Disconnect switch, on wall Lock
Pneumatic Valve, on unit Ball valve lockout device

Step 2: Notify Others (List all personnel who must be notified prior to equipment shutdown).

Users of the compressor

Any other Technicians, Mechanics, etc working in the area.

Step 3: Shutdown Equipment (List normal stopping procedures for equipment)

Shutoff compressor utilizing normal procedures.

Step 4: Isolate Equipment (List procedures for disconnecting each energy source)

Locate the electrical disconnect switch labeled "Comp 214". Turn the electrical disconnect switch
"off".
Locate the ball valve which controls the flow of air. Close the ball valve.

Step 5: Lockout/Tagout the Equipment (Control methods are to be noted in "Step 1" of form)

- Attach lock(s) and tag(s) to the electrical disconnect energy isolation device.
- Attach lock(s) and tag(s) to the ball valve energy isolation device.
- Ensure all tags indicate name of lock holder and date applied.

Step 6: Release or Block Stored Energy (List procedures for dissipating stored energy)

Open bleed valve on the pneumatic line if available.

Step 7: Verify Isolation (List procedures for attempting restart or otherwise ensuring effectiveness of LOTO)

Attempt to restart the compressor in order to ensure all systems are shutdown.

Step 8: Perform Required Servicing

 PSU LOTO Program
Issue Date: August 20, 2010

- During completion of work, avoid taking any action that could potentially reactivate the equipment.

Step 9: Release from Lockout/Tagout

- Remove all tools from the work area.

- Replace all equipment guards.
- Notify all affected & other employees of impending energization.
- Remove all locks, tags, and lockout devices.
- Ensure area is clear prior to restart.