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Bloqueo
Verificación Etiquetado
7% 11%

Aislamiento
82% 2
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 P E LIGRO
NO OPE RAR

DISPOSITIVOS ELECTRICOS
Fecha de expedición: _____________________________________
Válido del _____________________ al _______________________
Nombre del Equipo _______________________________________
Responsable de la tarjeta y/o candado:
_______________________________________________________
Trabajo a realizar: ________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Nombre de la persona que autoriza el bloqueo:
_______________________________________________________

NO RETIRE ESTA TARJETA

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