Scottsdale

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Lockout/Tagout Program Agreement

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The City of Scottsdale is committed to providing a safe work environment. Compliance with all Occupational Safety and Health Standards is required of all contractors performing work. All outside personnel working in or around energized equipment or processes shall read and agree to provisions outlined below prior to beginning work.

COMPANY NAME *

AUTHORIZED REPRESENTATIVE *

PERMIT NUMBER *

PROJECT ADDRESS *

Type(s) of Equipment being locked/tagged out *

I have read and understand the requirements of OSHA 29 CFR 1910.147 Control of Hazardous Energy (Lockout/Tagout).

I will adapt and enforce all requirements of OSHA 29 CFR 1910.147 while working at the city of Scottsdale.

I will notify the contract administrator prior to application of lockout/tagout devices. Also, our employees will not defeat any lockout tagout device that has been applied by another person.

Created by AIPSS

Scottsdale

Lockout/Tagout Program Agreement

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