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Tag-Out / Out-of-Service Notice

Attach this notice to defective or unsafe equipment

Company logo

PAGE 1 OF 2

Equipment Details

Equipment / Asset ID

Description

Make / Model

Serial Number

Site / Location

Registration / Fleet No.

Reason for Tag-Out

Describe the fault, defect or reason this equipment has been taken out of service:

Hazard Description

Type of hazard (tick all that apply):

Electrical Mechanical Hydraulic Pneumatic Structural Fire risk Chemical / spill Pressure Other

Describe the specific hazard to personnel if this equipment were operated:

Tagged By

Name (print)

Position / Role

Contact (phone / radio)

Company / Employer

Date Tagged

Time Tagged

Signature

Reported To (supervisor / maintenance)

Expected Repair

Expected Repair Date

Assigned To (repairer / contractor)

Work Order / Job Number

Tag-Out / Out-of-Service Notice - Page 2 of 2

Asset ID

Date tagged

Repair / Action Taken

Describe the repair, replacement or corrective action completed:

Repaired By (name)

Company / Employer

Date Repaired

Time Repaired

Repairer Signature

Authorised Return to Service

I confirm that the above repair / corrective action has been completed, the equipment has been inspected and tested (where applicable), and it is safe to return to service.

Authorised By (name - print)

Position / Role

Date Cleared

Time Cleared

Authorised Signature

Company / Employer

Additional Notes

Filing & Record Keeping

Once the equipment has been returned to service, remove this tag and file it with the asset's maintenance records. Keep completed tags for a minimum period as required by your organisation's document retention policy, WHS legislation and any contractual obligations.

Tag-Out / Out-of-Service Notice

⛔ DO NOT OPERATE

⛔ DO NOT REMOVE THIS TAG