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MANUAL HSE
Anexo 4
Seguridad, Salud Ocupacional Procedimiento HSE 2.21
y Medio Ambiente Revisión B, Agosto 2012
Pagina 1 de 1

Equipo de Bloqueo Adicional

Additional Equipment Isolation Attachment 4 Page ___ of ___

Project Name / Location: : CVPUE / Arequipa / A6CV Lock Box Number:

Clearance Number (enter number from associated LOTO Clearance)

Device or Equipment Isolated Position Application Removal

Tag Lock # (list affected equipment) (Open/Closed/Off/ Date / Time / Initial Date / Time / Initial
On/Etc.)
System Authorized Employee

Comments or Additions:

/CONVERSION/TMP/ACTIVITY_TASK_SCRATCH/572777226.DOC