10032026_CoHE _V5

Safety training

Control of Hazardous Energies Standard / V5 10032026

Permit issued:

Do you confirm that all the above isolations have been carried out and a safe work condition has been established? ☐

Do you confirm that the following elements are fully available / implemented?

Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐ Yes: ☐ - No: ☐

All equipment shut down by normal stopping procedures

All energy sources isolated

All energy isolating equipment "locked out" with adequate lockout devices

All energy isolating equipment tagged

All potentially hazardous sources or residual energy purged or dissipated

Verification of effectiveness of the isolations

Adequate rescue means available

All personnel affected by machine/equipment shutdown notified

Adequate PPE worn by all concerned person

All PPEs in good condition

Work area clear and demarcated

Nearby workers informed of work to be performed

Means for preventing access to unqualified persons from the work area in place

Additional safety measures in place - Yes: ☐ , No: ☐ . If yes, please describe below in detail.

Examples of situations where additional safety measures could be needed:

Note

Lightning risk on the day

Working at heights in certain areas

Requirements for other permits such as hot work permits

Other tasks being carried

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