Locked out by: 4 Energy Source: Location: [Insert Picture] Procedure: Locked out by: 5 Energy Source: Location: [Insert Picture] Procedure: Locked out by: GROUP LOTO: WAC 296-803-50050 Determine which procedures to use if more than one person will be involved in the LOTO procedure More than one person will be involved in this procedure If group LOTO will not be used, skip to next section Yes No No Choose a group LOTO method: A hasp will be used for this procedure A lock box will be used for this procedure Lock box identification #: A Primary Authorized Person Name:
Locked out by: 4 [Insert Picture] Energy Source: Location: Procedure: Locked out by: 5 [Insert Picture] Energy Source: Location: Procedure: Locked out by: GROUP LOTO: WAC 296-803-50050 Determine which procedures to use if more than one person will be involved in the LOTO procedure More than one person will be involved in this procedure If group LOTO will not be used, skip to next section No Yes No Choose a group LOTO method: A hasp will be used for this procedure A lock box will be used for this procedure Lock box identification #: A Primary Authorized Person Name: