DOE/EH-0180 --- Issue No. 91-04 --- 03/91


Control of Hazardous Energy


The Occupational Safety and Health Administration (OSHA) reports that 10 percent of serious industrial accidents are a direct result of the failure to adequately control hazardous energy. OSHA issued the final rule, with corrections and technical amendments, "Control of Hazardous Energy (Lockout/Tagout)" in September 1990. This standard requires "employers to develop an energy control program consisting of written procedures for shutting off and disabling machines and equipment whenever maintenance or servicing are performed on those machines and equipment, the instruction in use of the procedure to employees and the periodic inspection of the use of the procedure." (Federal Register, Vol. 55, No. 183, Thursday, September 20, 1990, Rules and Regulations)


Regulatory Guidance


The Code of Federal Regulations (CFR), Title 29, Part 1910, Section 147, "Control Of Hazardous Energy Rule,"and Order DOE 5480.19, "Conduct of Operations Requirements for DOE Facilities," Chapter IX (Lockouts/tagouts), establish minimum requirements for the control of unexpected energizing and the start-up (or release) of stored energy or toxic material that could cause injury to employees. These standards focus on procedures; specifically, procedures that are necessary to provide effective control when dealing with potentially hazardous energy or toxic material sources. Both standards are generic in nature, recognizing that some modifications or "tailoring" of the requirements may be necessary. The procedural provisions of 29 CFR 1910 are designed to be used throughout general industry in a wide range of applications. Appendix A, "Typical Minimal Lockout or Tagout System Procedures," of this rule provides an example of a simple lockout procedure. Also, detailed instructions on inspection procedures and interpretive guidance are available from OSHA, Directorate of Compliance Programs (OSHA Instruction STD 1 - 7.3). Chapter IX of Order DOE 5480.19, C.2. (Guidelines - Lockout and Tagout Implementation) also contains valuable administrative guidance for an effective Lockout/Tagout program.


Incidents At DOE Facilities


Since 1985, there have been approximately 50 reported occurrences at DOE facilities associated with lockouts/tagouts. At one DOE facility, two conflicting tags were attached to a valve on a tank that was empty and out-of- service. One tag directed that the valve be closed, the other directed that the valve be open. There was no way to easily ascertain which tag was accurate. Management determined that this error was made because there were no formal, written procedures for installing or removing locks or tags.

Currently under investigation at a DOE plant is an incident in which "Stop--Do Not Operate" tags were violated on four circuit breakers that provide electric power to isolation valves. A process building operator was told to energize the circuit breakers and followed the instructions without advising the building supervisor of the "tagged" status of the equipment. As a result of the violation, a valve opened, and a large amount of "wet air" entered the process system causing a violent surging throughout the system. This disturbance resulted in the deblading of seven compressors at various locations in the process building. Adherence to the tags' instructions (i.e., "Stop--Do Not Operate") would have prevented the incident. Additionally, adherence to communication procedures in DOE 5480.19 should have precluded the miscommunication.


Recommendations


The following elements are recommended for a successful lockout/tagout program.

  • Detailed procedures are developed, validated, and used for control of hazardous energy and toxic material sources. The procedures should clearly state the scope, purpose, authorization, rules, and techniques of the lockout/tagout program.

  • Assigned duties and responsibilities, including transfer of responsibilities for oncoming shift crews accepting control of the system involved prior to the release of control by the offgoing employees.

  • Extensive training programs to teach employees about the energy control procedures, including the use of tags and locks, and the importance of obeying them.

  • Periodic reinforcement training.

  • Disciplinary actions for both supervisors and employees who violate lockout/tagout procedures.


This Safety Note is one in a series of publications issued by EH to share occupational safety and health information throughout the DOE complex. For more information, contact Eleanor Crampton, Performance Assessment Division, Office of Environment, Safety and Health, U.S. Department of Energy, Washington, DC 20545, telephone (301)903-3732.


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