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Isolation Work Instruction Template
Corporate Safety - Template
Isolation Instruction
Doc no.
TEM-00077
Version date:
21/03/2016
Trim ID:
Doc owner:
J. Paige
Doc approver:
Manager, WHS
Rev no.
1
Page 3 of 4
The controlled version of this document is registered. All other versions are uncontrolled
Section 4 – De-isolation procedure
Step
Isolation Point Number / Description
Isolation Point Location
Isolator Name
Initial
1
Access Officer / Duty Operator contacted before commencing de-isolation.
2
3
4
5
6
7
8
9
10
5
Section 5 – Inch and test procedure
Equipment to be Tested:
Type of Test:
Reason for Test:
Step
Isolation Point Number / Description
Date / Time
Re-energiser Name
Initial
Re-isolator Name
Initial
1
2
3
Section 6 – Reinstatement
I confirm that all isolation equipment has been removed from isolation points, all isolated energy sources have been reinstated and the plant is available for normal operations.
Isolation Officer
Name:
Date:
Signature:
Time:
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source: seqwater.com.au
Isolation Work Instruction Template