Professional Documents
Culture Documents
Note: If additional work or Authorized Employees, attach an Additional Employee Clearance Sheet (see Attachment—C).
Additional Equipment Isolated? Y N (if yes, complete and attach an Additional Equipment Isolation Sheet, see Attachment D)
LOTO Issued To
LOTO Released By
(Authorized Employee print and sign name and list Lock #, Home and Date / Time Date / Time
(System Authorized Employee sign name)
Work Phone Numbers)
L#
H W
L#
H W
L#
H W
L#
H W
Additional Authorized Employees? Y N (if yes, complete and attach an Additional Employee Clearance Sheet, see Attachment C)
Primary
/conversion/tmp/activity_task_scratch/530148470.doc
MANUAL HSE
Seguridad, Salud Ocupacional
y Medio Ambiente
Anexo 2
Procedimiento HSE 2.21
Rev 00, Junio 2013
Pagina 2 de 2
/conversion/tmp/activity_task_scratch/530148470.doc