GTG-HSE-EXP-TEM-XXXX
ENERGY ISOLATION INSPECTION CHECKLIST
Inspector full name: Position: Date&Time:
Permit number: Location:
Description of job carried out:
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General requirements YES NO NA
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1 Before beginning the isolation, a risk assessment is carried out.
During job planning, an isolation plan is developed that identify all locations to be isolated, types of
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isolating devices to be used and site/job-specific procedures for isolating the equipment.
All necessary isolation and blinding equipment/devices (locks, tags, properly rated blinds, etc.)
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are made ready and inspected before commencing work
All forms of isolation (electrical, mechanical or otherwise) use the Lock/Hold Tag at every isolation
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point.
Is the following information available on all tags: 1. The nature of the work 2. Plant number/location.
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3. Date and time of lockout. 4. the individual who installed the isolation device.
6 Are the keys returned to a specific key box? (PTW office).
7 Isolation is done through the use of isolation certificates, attached to a work permit.
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Process/Mechanical isolation requirements YES NO NA
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Piping or equipment is isolated and/or blinded and the contents drained, vented or purged before
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work is performed.
2 The levels of isolation are applied according isolation procedure GTG-HSE-EXP-PRO-0031-rev01.
3 Single block valve is utilized, fluid is removed and valve tested for leakage before commencing work.
4 DB&B is utilized, vents and drains are verified and clear of obstruction.
DB&B is utilized, a hose or hard piping is attached to the drain valve to ensure that any liquid that
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might pass is carried away from the work site.
Safety precautions are taken (e.g., use of respiratory equipment) for removing blinds since
6 hazardous materials might have accumulated between the blind and the corresponding isolated
valve if the valve was passing.
A Permit is issued before commencing blinding activity. associated equipment and piping are
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isolated by closing block valves, depressurization, draining and purging.
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Electrical isolation YES NO NA
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It is not possible to lock out, isolation is accomplished by removal of fuses, disconnection of
1 electrical cables, or physical removal of a component of the system supplying energy to the
equipment. The point of physical interruption is identified with a fully completed hold tag.
2 Appropriate personal protective equipment provided and used during the isolation
3 Verified that the equipment is de-energized. (VAT)
Remarks and recommendations:
