LOTO — 3S PULSE

LOTO Details

Project*

WTG #*

Date*

Owner Representative Name

Time On*

Isolation & Verification

LOTO Provided Procedure

Remote Isolation Points

Control Center Notified

Clearance Number

Work & Equipment

Description of Work to be Performed*

Device and Equipment Information

Photos

Equipment, isolation points, applied locks/tags.

Affected Employee Acknowledgements*

Every affected employee working under this LOTO signs to acknowledge the energy isolation. Each person signs in turn on this device (up to 8). Release signatures are captured later when the LOTO is removed.