Power Engineering World Co.

(PEW)
Training form Lockout & Tag out

Trainee:.....................................................................................

Employee number:....................................................................................

Job title: ....................................................................................

Department: ......................................................................................

Date: / /

The employee has completed the Lock & Tag out training program which included:

1. Training on the repercussions of the locking and activating energy sources

2. Processing equipment to extinguish before the closure of energy sources.
3. Method of using the equipment to lock the system.
4. How to ensure the effectiveness of closing.
5. The potential risks and consequences of non-activation system
6. Reboot steps
7. Equipment necessary
8. Other topics................................................................................................................................
………………………………………………………………………………………………………

safety manager name Trainer name Trainee name and

and signature and signature signature

Rev.: 0 1 Page 1 of EHSP3-F1