Name of Applicant:

Name of Assessor:

Field Test Location:

Date:

Occupational Health and Safety

Assessment Method:
Demonstrates the lock-out and tag-out procedure.
Assessment Criteria Results
  • 1. Shuts down the equipment.
  • 2. Disconnects the power supply or has it disconnected.
  • 3. Notes clearly on a plastic tag-out tag the problem with the equipment.
  • 4. Attaches a ‘lock-out’ tag to the ignition switch and ensure that it is visible.
  • 5. Advises the supervisor ASAP of the problem.
  • 6. Follows the instructions of the supervisor to either remove the equipment or leave it as is.
  • 7. Secures the broken equipment with a padlock.
  • 8. Retains the key until the machinery is repaired.
 100% of assessment criteria — all criteria are required.

Outcome:

/8

Comments: