ENERGY ISOLATION LIST

EIL Ref. # Page __ of __

LOTO No. LOTO Box No. PTW Ref No. Points of Isolations defined by: Name of Permit Issuer Signature Date

Isolation Verification De-Isolation

Initial Position
Sequence No. Equipment ID (KKS No.) Isolation Description Lock No. Isolated State Isolation by Deisolated State Deisolation by Notes
(Open/Closed) Date Date Verified by (with signature) Date
(open/closed) (with signature) (open/closed) (with signature)

Comments or Special Conditions

COA-SHE-001-F048
Rev.00 / 2021.01.30