Employee Safety Orientation and Lockout Tagout Procedure Form

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This form is used to document employee completion of safety orientation and lockout tagout procedures. It ensures employees understand safe work practices, hazards, and equipment-specific lockout/tagout procedures before starting work on or near equipment that has the potential for sudden start-up or release of energy.

Implementing an Employee Safety Orientation and Lockout Tagout Procedure Form can benefit your organization in several ways:

• Reduces risk of workplace injuries and fatalities by ensuring employees understand safety protocols and procedures
• Improves productivity by minimizing downtime due to equipment-related incidents
• Enhances employee engagement and morale through a clear understanding of their roles and responsibilities in maintaining a safe work environment
• Complies with regulatory requirements and industry standards, reducing the risk of fines and penalties
• Provides a standardized process for managing lockout/tagout procedures, ensuring consistency across departments and shifts
• Facilitates training and documentation of safety protocols, making it easier to onboard new employees and ensure continuity in safety practices
• Helps identify and mitigate potential hazards before they become incidents, promoting a culture of safety and continuous improvement.

Employee Identification Information

• Name
• Job Title
• Supervisor's name
• Department

Hazardous Energy Source Identification

• List of all hazardous energy sources present in the work area (e.g., electrical, mechanical, chemical)
• Type and description of each source

Lockout/Tagout Device Assignment

• Lockout devices assigned to each energy source
• Tag-out devices assigned to each energy source
• Location of lockout/tag-out devices stored when not in use

Personal Protective Equipment Requirements

• List of PPE required for safe performance of tasks (e.g., gloves, safety glasses, respirator)

Work Area Description

• Detailed description of work area, including location and layout

Emergency Procedures

• Evacuation routes
• First aid procedures
• Fire extinguisher locations

Training and Certification Requirements

• Training requirements for employees performing specific tasks
• Certifications required for employees performing specific tasks (e.g., confined space entry)

Review and Acknowledgement

• Employee's review of the procedure form
• Employee's acknowledgement of understanding and agreement to follow the procedure