Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 5 38 of 53 8 C I R C U M VEN T I ON OF L OC K OU T T A GOU T Doc u m e n t Identif icat ion F R M 055 P age Nu m b e r 1 of 2 Doc u m e n t C r e ation Dat e Apr il 5 2016 Im p le m e n tat ion Dat e Apr il 8 2016 Ow ne r of L oc k Da te C olor of L o c k Equipm e nt L oc k e d Out To r e move the lock th e f oll owing must be c ompl e te 1 Disc uss wit h iss uing a uth oriz e d indi vidual a nd re sponsi ble supe rvisor the n e e d to re move th e lock All must be in ag r e e ment b e f ore the loc k is re mov e d 2 C he c k if loc k owne r is not ava il a ble I f y e s then ha ve the ow n e r r e move t he ir lock I f not a tt e mpt to c ontac t t he own e r I f re c e ive O K to r e move the lo c k then r e move the lock a nd c ompl e te this for m 3 I f una ble to c ont a c t t he l oc k owne r p roc e e d to s tep 4 4 Notif y the b ra nc h m a na ge r or de si g na t e S upe rvis or or de si g na te must info rm w orke r s of loc k re moval be for e th e y star t wor k th e following shi ft 5 R e move loc k with wit ne ss C ompl e te f orm O btain si g na tur e s a nd r e turn f or m t o bra nc h mana ge r I s P e rson A va il a ble Ye s No Time I f No the n C a ll P e rson a t Home Ma nda to r y Time W a s c ontac t m a de with t he pe rson Ye s No Time I f No the n supe rvisor l e a d ha nddesi g na te to infor m bra nc h mana ge r or de sig na t e of loc k r e mova l Ma nd a tor y Time C omm e nts P e rson w ho re moved th e lock W it ne ss t o lock r e moval De sig n a ti on De sig n a ti on S ig na ture S ig na ture Da te of L o c k R e moval Da te of L o c k re moval S ig na ture s to a c knowle d g e c irc umvention of lo c k out had ta ke n plac e B ra n c h Ma na ge r N a me B ra n c h Ma na ge rs S ig na ture B ra n c h Ma na ge r S ig na ture J HS C W orke r Re p Na me J HS C W orke r Re p S ig na ture Da te The c ompl e ted doc um e nts m ust be r e taine d for tw o y e a rs