UCSF Mission Bay Campus, Engineering Department
LOCK-OUT TAG-OUT POLICY
All Engineers are required to know and follow this Lock-out Tag-out policy to ensure the control or release
of hazardous energy and to prohibit unauthorized personnel or remote control systems from unexpectedly
energizing, starting up or releasing energy, or activation of machinery or systems while they are being repaired,
cleaned and/or serviced.
The LOCK-OUT TAG-OUT POLICY REQUIRES THESE PROCEDURES TO BE FOLLOWED:
GENERAL LOCK-OUT TAG-OUT PROCEDURES
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IDENTIFY the types of energy sources used, potential hazards, and all control devices.
NOTIFY all affected employees
TURN OFF all operating controls.
LOCATE all energy sources.
ISOLATE all energy sources by blocking, bleeding and venting stored energy as found in springs,
hydraulic systems, and pneumatic systems.
LOCK OUT all switches and energy controls in the ‘OFF’ or ‘SAFE’ position.
TEST the operating controls. Put all controls in the ‘ON’ position. Be sure nobody can get hurt before
testing.
RETURN all operating controls to the ‘OFF’ position.
PERFORM required task.
REMOVE LOCK-OUT devices only after the equipment is fully assembled and all the affected
employees have been notified. Each lock-out device must be removed by the person who put it on.
All Journeyperson Stationary Engineers are authorized and responsible for implementing and controlling
Lock-out Tag-out procedures. Apprentice Engineers may participate in LOTO operation under the direct
supervision of a Journeyperson. Utility Engineers may not participate in LOTO procedures. The Chief Engineer or
Assistant Chief Engineers are responsible to enforce this Policy, conduct inspections, training and certification of
authorized employees (Engineers)
All Engineers are responsible for following the ABLE Lockout Tag out Program, knowing and understanding
the Lockout Tag out definitions and attend yearly training.
Each authorized employee will be trained in the recognition of hazardous energy sources, type and magnitude
of the energy available in the workplace, and the method and means for isolation and control.
All Engineers are authorized to use only the durable locks, standardized tags and devices supplied by the
UCSF MBC Engineering Dept. Locks are identified by the Engineers’ ID number or Engineering Dept.
Tags should by filled out and include Engineer initials and Eng. Dept.
All Engineers must be knowledgeable of the different energy sources and the proper sequence of shutting
off or disconnecting energy.
Four types of energy sources are: 1) Electrical, 2) Mechanical, 3) Hydraulic & Fluids, 4) Gases or Pneumatic.
Forms of potential energy are: Hydraulic or pneumatic pressure, pressure below atmospheric (vacuum),
compressed or extended springs, potential energy due to gravity, stored mechanical energy (as in flywheels, etc)
static electricity, stored electrical energy (batteries, capacitors) thermal energy (high or low temperatures), residual
chemicals which may cause thermal, pressure, or chemical reactions, and radioactivity.
If potential energy is present in any form, care must be taken to ensure that the residual energy is reduced to a
non-hazardous level.
More than one energy source can be utilized on some equipment, and the proper procedure must be followed in
order to identify energy sources and lock-out tag-out accordingly.
Cord and plug equipment which can be protected from accidental start up by unplugging the equipment from the
energy source and by the plug being under the exclusive control of employee performing the service or repair need
not be Locked and Tagged out.
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UCSF MISSION BAY CAMPUS ENGINEERING DEPT. LOCK-OUT TAG-OUT POLICY (cont.)
If an energy isolating device cannot be locked out, an Engineering Dept supplied tag shall be attached (cable
tied) and properly filled out using permanent marker. Further effort to safe off the energy source should be made
(remove valve handle, cover device with tag, etc)
Use a permanent marker (sharpie) to fill out Lock-out Tags with pertinent information, including Engineers’
identification (initials OK) Engineering Department (Eng. OK) and attach Tag to lock shackle.
Locks, Tags, and isolation devices should be returned to the LOTO areas. Tags will be cleaned on a regular
basis and reused.
Each Engineer (Authorized Employee) shall use their individual Lock-out lock and Tag on any single piece
of equipment they alone are working on, and record same in Lock-out Tag-out log.
Every Engineer (Authorized Employee) working as a group on any equipment shall use their individual
Lock-out lock and Tag utilizing a multiple lock scissors clamp, and remove it when their work is
completed, and record same in Lock-out Tag-out log.
General equipment Lock-out and Tag-out shall be done with Eng. Dept. Lock-out locks and recorded in Lockout Tag-out log. Individual Lock-out locks and Tags shall be used while an individual Engineer is working on that
equipment. General equipment Lock-out Tag-out (LOTO) forms shall be used and attached to the equipment in a
conspicuous place (i.e.: control panel of chiller or boiler.)
Lock-out and Tag-out spanning multiple shifts shall be done using Eng. Dept. Lock-out locks and recorded in
Lock-out Tag-out log. The job lead Engineer, Asst. Chief Engineer, Boiler Watch Engineer, or other designated
Engineer shall be the Primary Authorized Employee responsible to maintain continuous control of the energy
isolating devices. All following shifts must be informed of Lock-out Tag-out status on shift turn over and via BMS
log entries.
Removal of an Engineers’ (Authorized Employee) Lock-out lock may be done by the Chief Engineer or
Assistant Chief Engineer: After verifying that the engineer is not at the facility, after making reasonable efforts to
advise the Engineer that his or her lock has been removed (can be done at return to work), and ensuring that the
Engineer has this knowledge before returning to work.
Outside Personnel/ Contractors shall be informed that Mission Bay Campus Engineering Dept has and enforces
Lock-out Tag-out procedures, and prohibited against attempts to restart or reenergize equipment that has been
locked or tagged out. All outside contractors are responsible for their employees to know and comply with this
policy. Outside Personnel/Contractors are required to inform Campus Engineers for their Lock-out Tag-out Policy
& Procedure. Both parties must sign acknowledgement form in LOTO binder.
All UCSF Mission Bay Campus equipment must be energized & de energized ONLY by UCSF Mission Bay
Campus Engineering Dept authorized staff using these procedures. The authorized Engineer will notify all
other Affected Mission Bay Campus Engineers, Contractors, and other personnel of Lock-out Tag-out
status or changes.
Periodic inspection (at least annually) by the Chief or Assistant Chief Engineer of every Engineers’ Lock-out Tagout procedure, understanding of that employees’ responsibilities regarding control of hazardous energy, and
physical inspection of LOTO procedure while performing work will be conducted and documented in LOTO binder.
This Lock-out Tag-out Policy is intended to provide a safe and positive means to control hazardous
energy and to protect all persons working on, or affected by equipment here, and to comply with OSHA
Standard 1910.147. Failure to comply fully with this Lock-out Tag-out Policy may involve discipline up to
and including termination, not to mention risk of serious bodily injury or death.
Chief Engineer approval: ______________________________ Date: ____________
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UCSF Mission Bay Campus
Engineering Department
CONTRACTOR LOCK-OUT TAG-OUT ACKNOWLEDGEMENT
Outside Personnel/ Contractors shall be informed that Mission Bay Campus Engineering Dept has and enforces
Lock-out Tag-out procedures, and prohibited against attempts to restart or reenergize equipment that has been
locked or tagged out. All outside contractors are responsible for their employees to know and comply with this
policy. Outside Personnel/Contractors are required to inform Campus Engineers for their Lock-out Tag-out Policy
& Procedure. Both parties must sign acknowledgement form in LOTO binder.
All UCSF Mission Bay Campus equipment must be energized & de energized ONLY by UCSF Mission Bay
Campus Engineering Dept authorized staff using these procedures. The authorized Engineer will notify all
other Affected Mission Bay Campus Engineers, Contractors, and other personnel of Lock-out Tag-out
status or changes.
EXCEPTION: With express prior permission for that day and time, contractors may open and close previously
identified branch circuits for routine work. All other LOTO procedures apply.
We certify that UCSF MISSION BAY CAMPUS ENGINEERING DEPT representative
Name: __________________________________________________________________________________________________
And Name: __________________________________________________________________________________________________
Of Outside Contractor: _________________________________________________________________________________________
Have informed each other of our respective Lock-out Tag-out Procedures:
Print Name: ____________________________________ Signature: ________________________________ Date: _________________
Print Name: ____________________________________ Signature: ________________________________ Date: _________________
Print Name: ____________________________________ Signature: ________________________________ Date: _________________
Print Name: ____________________________________ Signature: ________________________________ Date: _________________
Print Name: ____________________________________ Signature: ________________________________ Date: _________________