Asset Identifiers:

15009

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Created by & Date:

Rick Davis, 8-17-2021

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Revised by & Date:

 

Facility:

Columbia Slough Pump Station

Asset Location:

In Wetwell

Asset Description:

 

Electric Motor, Pump, # 1, Sewage

 

 

 

SYMBOL

ENERGY TYPE

X

MAGNITUDE

 

SYMBOL

ENERGY TYPE

X

MAGNITUDE

image

Chemical

   

image

Electrical

X

480 V A/C

image

Mechanical

   

image

Hydraulic

  

image

Thermal

   

image

Pneumatic

  

image

RF Radiation

   

image

Gravitational

  
        

Check

Lockout Application Process

Check

Lockout Removal Process

 

Notify affected Personnel.

 

Ensure all tools and items have been removed.

 

Properly shut down unit.

 

Confirm all employees are safely located.

 

Isolate all energy sources.

 

Verify controls are in neutral.

 

Apply all lockout devices

 

Remove lockout devices and re-energize the unit.

 

Verify total de-energization of all sources.

 

Notify affected employees servicing is completed.

 

#

Energy

Lockout Location

Method

Type of Device

1

 

 

image

 

 

Local Disconnect or MCC

Open disconnect unplug if possible

and/or open breaker at MCC

Tree, tag & lock

2

 

 

 

 

 

 		   

3

 

 

 

 

 		   

4