Isolation Procedure Template: Energy Isolation
A template for creating equipment-specific isolation procedures. Covers identification of energy sources, isolation methods, verification, and lockout/tagout requirements.
Isolation Procedure Template
Equipment Identification
Equipment name: ________________________________________________
Equipment ID / tag number: _____________________________________
Location: _____________________________________________________
Equipment type: _______________________________________________
Energy Sources to be Isolated
☐ Electrical: Main isolator location: ___________ Tag #: _____
☐ Pneumatic: Supply valve location: ___________ Tag #: _____
☐ Hydraulic: Supply valve location: ___________ Tag #: _____
☐ Steam: Supply valve location: _____________ Tag #: _____
☐ Process fluid: Isolation valve location: _______ Tag #: _____
☐ Stored mechanical (spring/flywheel): ________________
☐ Gravity (raised components): ___________________________
☐ Other: _________________________________________________
Isolation Steps
1. Notify affected personnel: _____________________________
2. Shut down equipment using normal procedure: __________
3. Operate each isolation device (open disconnect, close valve):
☐ Electrical isolator opened
☐ Pneumatic supply valve closed
☐ Hydraulic supply valve closed
☐ Other energy sources isolated
4. Bleed/release stored energy: _________________________
5. Apply personal locks and tags to each isolation point
6. Verify zero energy: __________________________________
☐ Attempt to start equipment (should not start)
☐ Test for voltage at motor terminals
☐ Verify zero pressure on all gauges
☐ Verify no stored mechanical energy
Restoration
1. Ensure all tools and personnel are clear: ______________
2. Reinstall all guards and safety devices: ______________
3. Close all bleed/drain valves: __________________________
4. Verify controls in off/neutral position: ______________
5. Each worker removes their own lock: ___________________
6. Notify affected personnel: ____________________________
7. Restore energy sources one at a time: ________________
8. Verify correct operation: _____________________________
Restoration completed by: ______________ Date: _________
Key Principles
- Each worker applies their own personal lock — no one else can remove it
- Group lockout: Use a lockbox — each worker applies their personal lock to the lockbox
- Verification of zero energy is mandatory — do not assume isolation is effective, prove it
- Emergency lock removal requires contacting the worker, verifying their safety, and documenting the removal
- Isolation procedures must be equipment-specific — generic procedures are not sufficient
- Procedures must be reviewed and updated whenever the equipment or process changes
Remember
An isolation procedure is a life-safety document. Never bypass, shortcut, or modify it. Every shortcut is a potential fatality.