@ BPGIC LOTO Audit Checklist Date & Time: . ft: . Stine 2 8-7-D0lA © \WidoodB™ D — Morwing Toial AoiveLOTO: 5s C Compliance a Checked Items Yes | No | N/A Remarks 1 | Is there a LOTO system in place? uve sen ve Ae ba. PRQUSE-GOE > | Soup COTO sali if more than two department are working See Abb Kyent oon same system? * wv 2 EfT 0559 3. | Are Tags also installed with respective Padlock? Sec allechusast | 4 | Are Tags properly filled and signed by? - vw Sec 2litbitasht 5 | Is the relevant Isolation certificate available in CCR? we ¥% ets fink Spy adschedle 6 | S the lock-out tag out certificate filled & singed off properly by » responsible people? ay Ceo 7 | sce ison certificate attached with the PTW and LOT: 295 & wvailable in workplace? “ vv mela wort PHAR 8. | Are the padlock keys available in the LOTO station? v 9 | Is the marked P&ID copy available with LOTO certificate? Zt _ 10 | Are all padlocks & Tags being in good condition? aw 11 | Is LOTO log sheet is updated in CCR? v & Zr ce eat hanes 12 Is the installed padlock number reflect in relevant isolation certificate? ~~ 13 | Is LOTO log sheet is updated in Maintenance department? v S. " ‘cc. eblech nA 14 | Operators & Technicians has been given LOTO training? kr, —— a lacduitd °F | 15 Is isolation Certificate number mentioned in PTW is same in jv Field? v Lee allechsH| Comments: ts cays ane aaslahe nl LO7O Ce dite bewe” Golleved by GW seh lant epi Obsewalteie Jp clateg Lz Zz Audit conducted by: Signature & date 4 {00 sm Form No. Revision No Date Page QISSE-FO-082 00 Tuly 2019 LofLLOCK-OUT AND TAG-OUT LOG SHEET essa | MSPS] osans| omg [eae | ogusn | Xarane 6-60 | Xam o5ey_|Pro-Hey [erg | 0530 eaforta | ema | Kanne | Venn | apni opal |'p30, | ZEN] osar | woiotin | oxen | Xpmne vrean | Karan _ | oee2 |e [aS | omer | /oyig | wense | Xbox | wave | xem ose | FEO, Leon [eres | riea | osson | dswK wapsea | to.soa_| Moone [65m | SUBswP | sams [obey | zopryra | aon | Baeone - | aoforttg | tron | Kessorne Gras [Mo ae fey TH] oses fayeryie | ettew | Laon ajorfa_| veroor | Krone se OBR ee RY Lary ta. | 0586 ze/aiq_ | OV5y | Keone 23)04/14 | \6.204 | oom 5 ser | Acunr | seem | eet looria | tavex | appar | or - - == esea | REE oy Oses | chziq| wnon | Racone | 2s festa | \6'-00% men | BO | vay | BBL [see] oeeq | pam | orsse | Geone _ L Form No. ___ Revision No ___ Date _ Page HSSEFO-013 00 24-09-17 1of¢€ BPGIC Lock-Out and Tag-Out Log Sheet eo) faa Ls re PAR emtopg | 13s x P30 %re Sep i [aay Poy sola, Ss he entlen s ss Res ea | i t i eee es Fh (Biawan| avn, [| ; | Te PERE ERS _ | + | / [ | | | |. | [tt] [ | | Set ite ee| IS v-toq os {2 awe eat] 7 = | aarsiy 50 | Ban ORS carly) Dou | DE Jor wang psf Venti p loan 6 pai [satan |g | e630 rent W320 | me lowell ee | ‘Lock-Out and Tag-Out Log Sheet i r 8350 | ve Pe etn nt | 93 20) va =] ao/onis ee | Deep ae | Eon [ole a4 | 8:30 Dem ae ‘ 27 [@stohg =a “ana pee eit: 2s] viry af vse. _ ~~ {| | [se fev Ip :3e Trae | s. a etait so i ____RevisionNo SS i | Date _ - 00, ee 24-09-17 - Tf 1@& BPGIC LOCK-OUT AND TAG-OUT LOG SHEET Form No. __HSSE-FO-013 289 veiase ie vygloaig | 4800 ae | Lo H9 goa [feetverr taaay | 0883 [eatentig | 10> 80 11091 Ba, |e B3IF} \gaq, | oasy [teloH4 IS: 20 16l0HN9 285 |n-KrR4od jgaqy| e885 |iaiertg | 52 0 Bete [Wrens] icaat | 0286 | atlorg | a:c0%m aoe qf ones | igjosig | Bie eo => = oT [228_| wy-votes sane | 08 [aaboaug | nso | sm | leet | anton 284 (iw - 29308] IsaBH | 9 989 Rafe | IF 20 | yews) ei | 22/099 ago [lic KLv> tooa S549.3 . I 2308, 2eaoal 17304 4 0890 | aaloaiq | Blo | Fewm Vonta) | 2aloHig wos. _P igees | | 24a (Mok pad asfouig | 68:10 | Faw | veel | astoaty 20404. | BIA | Wus~aomg t509q | Nag 0299] AxfoAlg | OB | maw | Bert} asleHiq YP 20 | | Sie + ___ Revision No | Date Page ofa¢ BPGIC LOCK-OUT AND TAG-OUT LOG SHEET¢ BPGIC Lock-out and Tag-out Log sheet Sp- 508 gan | eee ara [elfen | sree [mal | Mri [aiaiq [isco | vend | ay }2%3 | wy — 1550. 273 |aeloeliq | Aiton | Lewai{ | way sofoe|iq| Bieo Loma) wt le, BOoNF lon [ier = aes. = |—— - = " - _| Jt leowoe, isa | 224 leapsng | zieem| Ur) | aay leaiettiq| 2300] lems | eo Zone: Zoaoe || sg _ — pas fas ara Bara | pes [osha [Bes | teal [wwe [ooh latte | ley | temas. | ais [RE wey Tenof are foamay [RS [aT [Al leqreay fice | een, eis pat. jwv=iooogp MO} 925 lab Jowig | tb!00 | Leng] tars, lostoaig | 4!wrq| pares or Kiv-yoour |} Ista jo 4 | Form No. Revision No Date Page HSE-FO-013 0 a __ 26-09-2017 lofi& BPGIC ‘Lock-Out and Tag-Out Log Sheet ——|poroisvava] [ise | 2Fe [Selig | B10 [Tow | ewe) | serouig] aso | re) | ke aosorracseal! ep | TT pop - aoiei. _Digaa, 1 a [pee au [eaienta [aS fiemey) | ed) | amas | meo| St) | aes Bowe 1, Rotea| PF 223 4 L 4 | Bo pve " fy ears) LS | | Form No. Revision No “Date 7 QHUsEFO0I3. od] t™~932D- Mecnayical PM OS @ tee gy our Area - \ Lock Box No. 01s) No. of Pad Lock Points o2 Cubica/CBNo. |S), / LF 2. Switchgear No. du Saranac + Checklist/Drawing attached Yes wa LY ASSOCIATED WORK PERMITS. Permit Type Permit No. ow 2u54 ISOLATION ‘Name Designation | Padlock No. i Date ; es | e585, : Xeon EG Tea Se/ F379 12228 fo-dion > (aa sf sori TEen a sTecy | ISse4 aHong DEISOLATIC Designation Mechenical Department Operations Department| ‘THE EQUIPMENT IS SAFE TO ENERGIZE ‘Name Designation | Padlock No. Sign Time | Date E&I Department Form No.: QHSSE-FO-012 Revision: 00 Date: 15 Sep 2017SAFETY INDUCTION _Reary Ac ONT Phu By Tre - Reqnication, Lock Box No. ss) ‘No. of Pad Lock Points ol Cubical/CB No. Dwr Broker Switchgear No. Srdwiduadl AC Checklist/Drawing attached Yes O ASSOCIATED WORK PERMITS, Permit Type Permit No. Signed Off Date Sans al; 234 J0%/14 E31 Teat* of Form No.: QHSSE-FO-012 Revision: 00 Date: 15 Sep 2017No. of Lock Out Points Area Equipment to be Isolated: Checklist/Drawing attached ASSOCIATED WORK PERMITS Permit Type Equipment No/ID Blind/Spade No. DicioseaBPGIC solations required for the following tasks/work: Lock Box No, No. of Lock Out Points, Area Equipment to be Isolated: ChecklisvDrawing attached ves J ASSOCIATED WORK PERMITS Permit Type Equipment NoJ/ID Isolation done by valve: [] Yes Ta __vaive Position: LJ open ‘Any comments:- Maintenance Licisea Operations: Contractor Designation Maintenance ContractorNo. of Lock Out Points Equipment to be isolated: Ye Ol ASSOCIATED WORK PERMITS Permit Type Equipment NoJ/ID_ Isolation done by valve: [_] Yes Cina falve Position: ~[_] Open@ BPGIC Tsolations required forthe following tasks/work: P-533,P-532.D- Mecwmica. PM 105 @] ter on guy Area Lock Box No. ©\ ss o2, Cubieal/CB No. 5 / HEL Checklisw/Drawing attached ey Surtearcene, a Signed Off Date 24/04/19,- @ BPGIC’ 'solations required for the following tasks/work: TRV ~ CALIBRATION WORK Lock Box No. Area en No. of Lock Out Points | 2 PUMP MANILD AREA ioment © be ote, [Berea TOE que Equipment to lated: wee 7 ge vs NAL] Checklist/Drawing attached ASSOCIATED WORK PERMITS. Permit Type Permit No. Signed Off Date Cw 2A bg 23/07h9 Equipment No./ID Blind/Spade No. A” bun Rane Line No. 92 ~PRY - 5003 Rest Room ARE FW UNE: SB ~ pRV - 500! @ evo Rane wv Quinn ew owe = Pav qe2e] ” f __Gvp Fuwwe | p- 402 Oe -~ Line Isolation done by valve: ‘es Cona /alve Position : Open Giosea Any comments:- §\2e%. LD nos! 18325, 1548b 15504. ove Loto NOS!— VHdb, (A998, VAAN Name Designation | Lock No. Sign Time Date Maintenance | rea mite [ECTS [ies | ai aefoAly Operations | shivering ops Perseze, | Coy S10 | sana A Contractor - Name Designation Lock No. ‘Sign Time Date Maintenance Contractor Operations orm No HSE ston No. 00