Health, Safety and Environmental Management Procedures Manual

Title: HS&EP23 Issue No. 02 Revision: 00

Controlled Copy Page: 9 of 10

ELECTRICAL ISOLATION TAG

Isolation Tag Number:

1.Equipment isolated and serial number:

2.Isolation location:

3.Method of isolation:

4.Isolated by:Name: Sign: Date/time:

5.Isolation
verified by: Name: Sign: Date/time:

6.De-isolated
by: Name: Sign: Date/time:

7.De-isolated
verified by: Name: Sign: Date/time:

13 September 2004 OP 07 Briggs Commercial Limited

Form No. F023D