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: Building: Location: Assessed By: Date Assessed: 2. Evaluation of Hazardous Energy Sources Energy Source 3. Magnitude Isolation Device Lockable Electrical Yes - â–¡ No - â–¡ Chemical Yes - â–¡ No - â–¡ Hydraulic Yes - â–¡ No - â–¡ Pneumatic Yes - â–¡ No - â–¡ Thermal Yes - â–¡ No - â–¡ Mechanical Yes - â–¡ No - â–¡ Radioactive Yes - â–¡ No - â–¡ Yes - â–¡ No - â–¡ Yes - â–¡ No - â–¡ Yes - â–¡ No - â–¡ Yes - â–¡ No - â–¡ Shut Down procedure Operating Contr.

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