RED TAG MASTER ADDENDUM ADDENDUM RED TAG MASTER NO. DATE: NUMBER: / FACILITY REPRESENTATIVE VERIFICATION NAME / SIGNATURE / JOB REPRESENTATIVE VERIFICATION NAME / SIGNATURE REASON FOR CHANGE SYSTEM CHECK OTHER: ADDENDUM DEPT / CRAFT / RELEASED IF ROSTER ACKNOWLEDGED SPECIFIC JOB/TASK LAST NAME (SIGNATURE) For USED (SIGNATURE) Temporary Changes CHECK EQUIPMENT COVERED BY ADDENDUM DESCRIPTION of CHANGE RED TAGs Is this a permanent change to the RTM or a temporary change that will be returned to the original isolation (example: temporary removal of a Red Tag to test rotation of a pump)? For permanent changes to this isolation update the Location Listing for this RTM by adding additional Red Tag(s) Permanent to the Location Listing. For permanently removed Red Tags, immediately reconcile each removed Red Tag on the Change: Location Listing and then dispose of it. Suggest including a reference to the Addendum Number next to each added/removed Red Tag. Each person who has currently signed Acceptance on the RTM must sign that they Acknowledge this change above. For temporary changes fill in the Red Tag information Each person who has currently signed Acceptance on Temporary the RTM must sign that they Acknowledge this change above. When the temporary change is no longer needed and Change: can be reset back to the original isolation, each person above must Release this Addendum and then the original isolation is reset. RED TAGS REMOVED TEMPORARILY RED TAG # (From original Location Tag Removed by Tag Re-installed by Location Listing)
RED TAG MASTER ADDENDUM RED TAG MASTER NO. DATE: ADDENDUM NUMBER: FACILITY REPRESENTATIVE VERIFICATION NAME / SIGNATURE / JOB REPRESENTATIVE VERIFICATION NAME / SIGNATURE / REASON FOR ADDENDUM CHANGE SYSTEM CHECK OTHER: SPECIFIC JOB/TASK DEPT / CRAFT / ACKNOWLEDGED (SIGNATURE) LAST NAME RELEASED (SIGNATURE) For Temporary Changes IF ROSTER USED CHECK EQUIPMENT COVERED BY ADDENDUM DESCRIPTION of CHANGE RED TAGs Is this a permanent change to the RTM or a temporary change that will be returned to the original isolation (example: temporary removal of a Red Tag to test rotation of a pump)? Permanent Change: For permanent changes to this isolation update the Location Listing for this RTM by adding additional Red Tag(s) to the Location Listing. For permanently removed Red Tags, immediately reconcile each removed Red Tag on the Location Listing and then dispose of it. Suggest including a reference to the Addendum Number next to each added/removed Red Tag. Each person who has currently signed Acceptance on the RTM must sign that they Acknowledge this change above. Temporary Change: For temporary changes fill in the Red Tag information Each person who has currently signed Acceptance on the RTM must sign that they Acknowledge this change above. When the temporary change is no longer needed and can be reset back to the original isolation, each person above must Release this Addendum and then the original isolation is reset. RED TAGS REMOVED TEMPORARILY RED TAG # (From original Location Listing) Location Tag Removed by Tag Re-installed by
IOES_RTM_Addendum_English.docx