Isolation Work Instruction Template - Free Download | Page 2
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Corporate Safety - Template
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Isolation Point Number / Description
Isolation Point Location
Access Officer / Duty Operator contacted before commencing isolation.
Section 3 – Test for dead / prove for dead procedure
Test Point Description
Test Point Location
I confirm that all identified energy sources have been isolated, all residual energy has been dissipated, all isolation points have been locked or otherwise
secured to prevent re-energisation, and the isolations have been tested and proven to be effective.
I have demonstrated the effectiveness of the isolation to all workers who are working under the control of the isolation.