final report

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The Control of Hazardous Energy (Lockout/Tagout) 2013 October 20, 2013 Health and Safety Department, Herbion Pharmaceuticals, Korangi Industrial Area, Korangi Karachi, Pakistan. Dear Sir/Madam: Helping you to improve your practices is of our highest priority. That is why we are pleased to submit the brief document outlining and to create a SAFER WORKPLACE. Mutually we can design system that is used to secure or isolate energy sources on process equipment during maintenance activities. We understand that you have been incorporating safe industrialized standards in your practices at your manufacturing facility. Although you have every reason to believe your workforce are pleased with employer satisfaction you provide, you would further like to give them safer workplace and environment. Let’s say site have a broken machine to fix in your plant. Your worker turns off the power to it and fixes it. Right? But what happens if your workers have got their fingers in there and somebody turns it back on. That is why it is smart to “tag out” critical electrical switches with a sign that says to leave the switch OFF. To be even safer, you can put a lock on the switch. That’s called a “lock out.” And that is why you are reading this now. OSHA standards at your manufacturing site wants you to be aware of the requirements for locking-out or tagging-out (controlling) energy sources during servicing and/or maintaining of machines and equipment. What requirements? Why the requirements that are spelled out in the Occupational Safety and Health Standard 1910.147, entitled “The Control of Hazardous Energy (lockout/tagout)”. We will look at the Standard and see how it is designed to help keep you safe from the potential hazards posed by machines and equipment. i

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Page 1: Final Report

The Control of Hazardous Energy (Lockout/Tagout) 2013

October 20, 2013

Health and Safety Department,Herbion Pharmaceuticals,Korangi Industrial Area, Korangi Karachi, Pakistan.

Dear Sir/Madam:

Helping you to improve your practices is of our highest priority. That is why we are pleased to submit the brief document outlining and to create a SAFER WORKPLACE. Mutually we can design system that is used to secure or isolate energy sources on process equipment during maintenance activities.

We understand that you have been incorporating safe industrialized standards in your practices at your manufacturing facility. Although you have every reason to believe your workforce are pleased with employer satisfaction you provide, you would further like to give them safer workplace and environment. Let’s say site have a broken machine to fix in your plant. Your worker turns off the power to it and fixes it. Right? But what happens if your workers have got their fingers in there and somebody turns it back on. That is why it is smart to “tag out” critical electrical switches with a sign that says to leave the switch OFF. To be even safer, you can put a lock on the switch. That’s called a “lock out.” And that is why you are reading this now.

OSHA standards at your manufacturing site wants you to be aware of the requirements for locking-out or tagging-out (controlling) energy sources during servicing and/or maintaining of machines and equipment.

What requirements? Why the requirements that are spelled out in the Occupational Safety and Health Standard 1910.147, entitled “The Control of Hazardous Energy (lockout/tagout)”. We will look at the Standard and see how it is designed to help keep you safe from the potential hazards posed by machines and equipment.

We will discuss the various types of energy sources and how to keep them from harming you. And, we will look at a typical energy-control program, including lockout vs. tagout along with lockout/tagout equipment.

We will discuss the requirements for training and retraining to keep you sharp and safe. We will see how to apply the program both to lockout/tagout procedures and finally, to procedures for restoring power.

Thank you for your consideration and time. We can be contacted quickly on our office address.

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Page 2: Final Report

The Control of Hazardous Energy (Lockout/Tagout) 2013

TABLE OF CONTENTS

I. Objective

II. Assignment of Responsibility

III. Level-1/ basic LOTO implementation strategy

IV. Procedures

A. Preparation for Lockout or Tagout

B. Electrical

C. Hydraulic/Pneumatic

D. Fluids and Gases

E. Mechanical Energy

F. Release from Lockout/Tagout

G. Service or Maintenance Involving More than One Person

H. Removal of an Authorized Employee’s Lockout/Tagout by the Company

I. Shift or Personnel Changes

J. Procedures for Outside Personnel/Contractors

K. Training and Communication

L. Periodic Inspection

V. Attachments

A. List of Authorized Personnel for Lockout/Tagout Procedures Form

B. Certification of Training of Authorized Personnel Form

C. Certification of Training of Affected Personnel Form

D. Lockout/Tagout Inspection Certification Form

E. Outside Personnel/Contractor Certification Form

F. Equipment Specific Procedure Form

VI. Samples

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Page 3: Final Report

The Control of Hazardous Energy (Lockout/Tagout) 2013

PROJECT CHARTER

1. Project NameThe control of hazardous energy (lockout/Tag out)

2. Project Business needSaving accidental treatment Cost

3. Project Goal, Benefits and objectives Safer work place Reduced Accidents Improve communication Reduce Downtime

4. Project dependency Implementation of OSHA standards

5. Project Constraints Careless workforce Equipments Availability Employee Morale

6. Project Assumptions Trainings are sufficient to implement the project Equipments will be available when needed Workforce will follow instructions

7. Project Risks Increase in downtime Communication gap Increase in employee dependency

8. Project Parameters Scope: To establish a means of positive control to prevent the accidental starting of

machines Schedule: Project will complete within 3 months of starting date. Cost: The maximum cost that can be assigned to this project will be Rs 0.3 million

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The Control of Hazardous Energy (Lockout/Tagout) 2013

9. Project Deliverables

Personnel Safety Increase Employee Morale Increase Job Satisfaction

Work Break down

10. Project Organization Quality Manager will act on behalf on his organization. In his absence Asst. Manager will take

the Responsibility. Mr. Wahaj Bin Jamal will act as project Manager. In his absence Mr. Salman Sheikh can be

contacted.

11. Key Stakeholders Employees Quality Department Director Contractor

12. Guiding principles Employee training program will be arranged by project team. Measures will be taken for uninterrupted production during project. Budget can subject to changes with change in government policies. The project team will warranty the equipments for 1 year.

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Implement Lock out/Tag out

Meeting

Budget Allocation

Arrange workshop

Order equipments

Training

System Implementation

Documentation

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The Control of Hazardous Energy (Lockout/Tagout) 2013

STAKEHOLDER ANALYSIS

S.No NAME SWOT INTEREST INFLUENCE COMMUNICATION

STRATEGY

1 Project Firm Opportunity Business High E-mail,Call

2 Quality Department Strength Certification High E-mail,Call

3 Maintenance Department Opportunity Safety Moderate E-mail,Call

4 Director Strength Business Low E-mail

5 Contractor Opportunity Business Moderate Call

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The Control of Hazardous Energy (Lockout/Tagout) 2013

RESPONSIBILITY ASSIGNMENT MATRIX (RAM)

S.No.

What is to be Done

(Activities)

Team member NameProject Firm Qaulity

DepartmentMaintenance Department

Director

Contractor

1Meeting

R C C I I

2Budget Allocation

C R S C I

3Meeting

R I S I C

4Order Equipments

R C C I A

5Training

A C R V I

6 System Implementation

S V R I I

7Documentation

S R A I I

Typical Role Definitions:

I – InformR – Responsible C – Consult S – Support

A- Accountable V- verify

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The Control of Hazardous Energy (Lockout/Tagout) 2013

LOCKOUT/TAGOUT PROCEDURE

I. OBJECTIVE

The objective of this procedure is to establish a means of positive control to prevent the accidental starting or activating of machinery or systems while they are being repaired, cleaned and/or serviced. This program serves to:

A. Establish a safe and positive means of shutting down machinery, equipment and systems.B. Prohibit unauthorized personnel or remote control systems from starting machinery or

equipment while it is being serviced.C. Provide a secondary control system (tagout) when it is impossible to positively lockout the

machinery or equipment.D. Establish responsibility for implementing and controlling lockout/tagout procedures.E. Ensure that only approved locks, standardized tags and fastening devices provided by the

company will be utilized in the lockout/tagout procedures.

II. ASSIGNMENT OF RESPONSIBILITY

A. Responsible Person will be responsible for implementing the lockout/tagout program.

B. Responsible Persons are responsible for enforcing the program and insuring compliance with the procedures in their departments.

C. Responsible Person is responsible for monitoring the compliance of this procedure and will conduct the annual inspection and certification of the authorized employees.

D. Authorized employees (those listed in Attachment A) are responsible for following established lockout/tagout procedures. An authorized employee is defined as a person who locks out or tags out machines or equipment in order to perform servicing or maintenance on that machine or equipment. An affected employee becomes an authorized employee when that employee's duties include performing servicing or maintenance covered under 1910.147, The Control of Hazardous Energy (lockout/tagout).

E. Affected employees (all other employees in the facility) are responsible for insuring they do not attempt to restart or re-energize machines or equipment that are locked out or tagged out. An affected employee is defined as a person whose job requires him/her to operate or use a machine or equipment on which servicing or maintenance is being performed under lockout or tagout, or whose job requires him/her to work in an area in which such servicing or maintenance is being performed.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

SCHEDULE MANAGEMENT PLAN

1. General Project Information Project Name: The control of hazardous energy

Location: Herbion PharmaProject Manager: Wahaj Bin Jamal

2. Objectives Schedule activities Synchronize planning Set priorities Assign job to each individual

3. Schedule Assumptions Safety personnel needs to rotate in shifts All personnel protective equipment will not be available during training session

4. Schedule Constraints Training date was set prior to procurement of all PPE’s Lack of trained resource availability

5. Schedule risks Difficult to shutdown machines during production run

6. Schedule change control Meeting is planned on weekly basis and all members are responsible to participate in it. Any change will be done with a final approval of project manager Change request form has been used for any change

7. Scheduling Process

Scheduling process is continued to update as project progresses after awareness session in the start.

Schedule is updated after every weekly meeting Entire project to be completed in three months

8. Schedule typesSchedule type used is

Gant Chart

9. Scheduling Responsibilities Scheduling responsibilities is handled by Mr. Abid Rasheed. Overall activities are to be reviewed by project manager

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The Control of Hazardous Energy (Lockout/Tagout) 2013

LEVEL-1/ BASIC LOTO IMPLEMENTATION STRATEGY

Awareness and importance of Lock out/ Tag out to organization personnel [PRESENTATION]

o TASK-1: What is LO/TO? And why it is necessary?

Identification for LO/TO [PRELIMINARY PREPERATIONS]: o TASK-1:

Identification of utilities area/ machinery and preparation of list of equipments. Identification of Authorized and Affected Personal for PDT.

o TASK-2: Decision of Fabricating Locks/ Import Locks.

Execution of LO/TO implementation : o TASK-1:

Ordering Locks/ Fabrication of Locks, Lockout Station. o TASK-2:

Delivery for LO/TO Equipments.

LO/TO implementation and Training[PROCESS IMPROVENT]: o TASK-1:

Documentation for Training, SOP, PDT (TAGS). o TASK-2:

Training.o TASK-3:

Demonstration of Procedure.

Milestone-5[PROJECT CLOSING & Preparation for Level-2]: o TASK-1:

User Check/ satisfaction. o TASK-2:

Handling of LOTO Equipment, documents and PDT.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

IV. PROCEDURES

The ensuing items are to be followed to ensure both compliance with the OSHA Control of Hazardous Energy Standard and the safety of your employees.

A.Preparation for Lockout or Tagout

Employees who are required to utilize the lockout/tagout procedure (see Attachment A) must be knowledgeable of the different energy sources and the proper sequence of shutting off or disconnecting energy means. The four types of energy sources are:

1. electrical (most common form);2. hydraulic or pneumatic;3. fluids and gases; and4. mechanical (including gravity).

More than one energy source may be utilized on some equipment and the proper procedure must be followed in order to identify energy sources and lockout/tagout accordingly. See Attachment F for specific procedure format.

B. Electrical

1. Shut off power at machine and disconnect.2. Disconnecting means must be locked or tagged.3. Press start button to see that correct systems are locked out.4. All controls must be returned to their safest position.5. Points to remember:

a. If a machine or piece of equipment contains capacitors, they must be drained of stored energy.

b. Possible disconnecting means include the power cord, power panels (look for primary and secondary voltage), breakers, the operator's station, motor circuit, relays, limit switches, and electrical interlocks.

c. Some equipment may have a motor isolating shut-off and a control isolating shut-off.d. If the electrical energy is disconnected by simply unplugging the power cord, the cord

must be kept under the control of the authorized employee or the plug end of the cord must be locked out or tagged out.

C. Hydraulic/Pneumatic

1. Shut off all energy sources (pumps and compressors). If the pumps and compressors supply energy to more than one piece of equipment, lockout or tagout the valve supplying energy to the piece of equipment being serviced.

2. Stored pressure from hydraulic/pneumatic lines shall be drained/bled when release of stored energy could cause injury to employees.

3. Make sure controls are returned to their safest position (off, stop, standby, inch, jog, etc.).

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The Control of Hazardous Energy (Lockout/Tagout) 2013

D. Fluids and Gases

1. Identify the type of fluid or gas and the necessary personal protective equipment.2. Close valves to prevent flow, and lockout/tagout.3. Determine the isolating device, then close and lockout/tagout.4. Drain and bleed lines to zero energy state.

5. Some systems may have electrically controlled valves. If so, they must be shut off and locked/tagged out.

6. Check for zero energy state at the equipment.

E. Mechanical Energy

Mechanical energy includes gravity activation, energy stored in springs, etc.

1. Block out or use die ram safety chain.2. Lockout or tagout safety device.3. Shut off, lockout or tagout electrical system.4. Check for zero energy state.5. Return controls to safest position.

F. Release from Lockout/Tagout

1. Inspection: Make certain the work is completed and inventory the tools and equipment that were used.

2. Clean-up: Remove all towels, rags, work-aids, etc.3. Replace guards: Replace all guards possible. Sometimes a particular guard may have

to be left off until the start sequence is over due to possible adjustments. However, all other guards should be put back into place.

4. Check controls: All controls should be in their safest position.5. The work area shall be checked to ensure that all employees have been safely

positioned or removed and notified that the lockout/tagout devices are being removed.6. Remove locks/tags. Remove only your lock or tag.

G. Service or Maintenance Involving More than One Person

When servicing and/or maintenance is performed by more than one person, each authorized employee shall place his own lock or tag on the energy isolating source. This shall be done by utilizing a multiple lock scissors clamp if the equipment is capable of being locked out. If the equipment cannot be locked out, then each authorized employee must place his tag on the equipment.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

H. Removal of an Authorized Employee’s Lockout/Tagout by the Company

Each location must develop written emergency procedures that comply with 1910.147(e)(3) to be utilized at that location. Emergency procedures for removing lockout/tagout should include the following:

1. Verification by employer that the authorized employee who applied the device is not in the facility.

2. Make reasonable efforts to advise the employee that his/her device has been removed. (This can be done when he/she returns to the facility).

3. Ensure that the authorized employee has this knowledge before he/she resumes work at the facility.

I. Shift or Personnel Changes

Each facility must develop written procedures based on specific needs and capabilities. Each procedure must specify how the continuity of lockout or tagout protection will be ensured at all times.

J. Procedures for Outside Personnel/Contractors

Outside personnel/contractors shall be advised that the company has and enforces the use of lockout/tagout procedures. They will be informed of the use of locks and tags and notified about the prohibition of attempts to restart or re-energize machines or equipment that are locked out or tagged out.

The company will obtain information from the outside personnel/contractor about their lockout/tagout procedures and advise affected employees of this information.

The outside personnel/contractor will be required to sign a certification form (see Attachment E). If outside personnel/contractor has previously signed a certification that is on file, additional signed certification is not necessary.

K. Training and Communication

Each authorized employee who will be utilizing the lockout/tagout procedure will be trained in the recognition of applicable hazardous energy sources, type and magnitude of energy available in the work place, and the methods and means necessary for energy isolation and control.

Each affected employee (all employees other than authorized employees utilizing the lockout/tagout procedure) shall be instructed in the purpose and use of the lockout/tagout procedure, and the prohibition of attempts to restart or re-energize machines or equipment that are locked out or tagged out.

Training will be certified using Attachment B (Authorized Personnel) or Attachment C (Affected Personnel). The certifications will be retained in the employee personnel files.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

L. Periodic Inspection

A periodic inspection (at least annually) will be conducted of each authorized employee under the lockout/tagout procedure. This inspection shall be performed by the (Responsible person) . If (Responsible person) is also using the energy control procedure being inspected, then the inspection shall be performed by another party.

The inspection will include a review between the inspector and each authorized employee of that employee's responsibilities under the energy control (lockout/tagout) procedure. The inspection will also consist of a physical inspection of the authorized employee while performing work under the procedures.

The (Responsible person) shall certify in writing that the inspection has been performed. The written certification (Attachment D) shall be retained in the individual's personnel file.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

COST MANAGEMENT PLAN

1. Project Information Project Name: Implementation of LOTO procedureLocation: Getz PharmaProject Manager: Wahaj Bin Jamal

2. Cost Assumptions Cost will not vary as project proceeds. All standard tools/services are available.

3. Cost Constraints Organizations budget

4. Cost Risks Government policies Taxes Exchange rates

5. Budget Sources and Approvals Project is funded by Herbion pharma Approved by senior top management

6. Cost Management Roles Project manager will intimate any change in budget after consultation with team members Approval of higher authority required if budget deviates more than Rs.50,000.

7. Project Estimation Techniques

Bottom up estimate has been used

8. Changes to the Budget Project changes are approved by sponsor but within limit of Rs. 50000 Initially planned for Rs. 3 million but end up with 3.25 million.

9. Cost and Expenditure tracking Total project cost is Rs. 3 million Training session costs Rs. 100,000 Equipment for each cost Rs. 50000, and we have total of 60 machines

10. Cost Closeout Initially planned for Rs. 3 million but end up with 3.25 million

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The Control of Hazardous Energy (Lockout/Tagout) 2013

11. Lessons Learned After project approval immediately place orders for equipments due to uncertain government

policies. Include exchange rate tolerance in your budget

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The Control of Hazardous Energy (Lockout/Tagout) 2013

QUALITY MANAGEMENT PLAN

1. General Project Information Project Name: The Control of Hazardous Energy

Location: Herbion PharmaProject Manager: Wahaj Bin Jamal

2. Quality AssumptionsThis involves

OSHA control system is followed Standardized equipment are used throughout

3. Quality ConstraintsThe below constraint will limit the quality team options

People involved in working are not aware of different energy sources that has been used

4. Quality RisksList any risks identified during the development of the quality management Plan. For example:

More than one energy sources are utilized on some equipment. But people are not trained accordingly

5. Setting Project Quality StandardsQuality standards should be followed to meet the utmost objective

Ensure quality complianc

e

Checklistof daily activitie

s

Periodic maintenan

ce

Implementation of OSHA

standard

Training session

No. of worker got

trained

Inspection

Provide PPE’s

Use of standardize locks and tags

Audits

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The Control of Hazardous Energy (Lockout/Tagout) 2013

5. Quality Assurance ProgramAs per below listed, quality assurance program has been set up

Implementation of lean six sigma at SGL will definitely help to review as it involves tagging on machines

Compliance with ISO and OSHA should be followed SOP are designed to perform logout and tag out of machines Third party audit will ensure current safety position Multi skill operator need to be trained with safety precaution Mistake proofing strategy is employed Pareto analysis has been done on all machines to identify those that switches to out of

order frequently

6. Quality Control ProgramOutline the Quality Control’ (QC) techniques that the project will implement. This may include any of the following actions:

Eliminate error by rectifying human procedure QC manuals are updated with revised SOP Machines cannot be switch on unless it passes desired criteria Weekly status report to be reviewed regularly Cause and effect diagram is used to rectify frequently occurred errors

7. Quality Roles and Responsibilities All quality related issues will handle by Mr. Abid. All team member will support to achieve high quality standards

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT A

List of Authorized Personnel for Lockout/Tagout Procedures

NAME JOB TITLE

_______________________________ ______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

_______________________________ _______________________________

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT B

Certification of Training(Authorized Personnel)

I certify that I received training as an authorized employer under Company Name

Lockout/Tagout program. I further certify that I understand the procedures and will

abide by those procedures.

________________________________________________ __________________ AUTHORIZED EMPLOYEE SIGNATURE DATE

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT C

Certification of Training(Affected Personnel)

I certify that I received training as an Affected Employee under Company Name

Lockout/Tagout Program. I further certify and understand that I am prohibited from

attempting to restart or re-energize machines or equipment that are locked out or tagged

out.

________________________________________________ __________________ AUTHORIZED EMPLOYEE SIGNATURE DATE

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT D

Lockout/Tagout Inspection Certification

I certify that Equipment was inspected on [this date] utilizing lockout/tagout

procedures. The inspection was performed while working on

Equipment .

________________________________________________ __________________

AUTHORIZED EMPLOYEE SIGNATURE DATE

________________________________________________ __________________

INSPECTOR SIGNATURE DATE

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT E

Outside Personnel/Contractor Certification

I certify that and (outside

personnel/contractor) have informed each other of our respective lockout/tagout

procedures.

________________________________________________ __________________

AUTHORIZED EMPLOYEE SIGNATURE DATE

________________________________________________ __________________

INSPECTOR SIGNATURE DATE

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The Control of Hazardous Energy (Lockout/Tagout) 2013

ATTACHMENT F

Equipment Specific Procedurefor

Company Name

(Date)

Machine Identification

General Description: _________________________________________________________________________________________________________________________________________ Manufacturer: ______________________________________________________________________________________________________________________________________________ Model Number: ________________________________________________________________ Serial Number:* ____________________________________________________________________________________________________________________________________________ * If more than one piece of same equipment, list all serial numbers.

Location of equipment: _______________________________________________________________________________________________________________________________________ Operator ControlsThe types of controls available to the operator need to be determined. This should help identify energy sources and lockout capacity for the equipment.

List types of operator controls: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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The Control of Hazardous Energy (Lockout/Tagout) 2013

Energy Sources

The energy sources, such as electrical, steam, hydraulic, pneumatic, natural gas, stored energy, etc.) present on this equipment are:

ENERGY SOURCE LOCATIONLockable

Yes NoType lock or block

needed

Shutdown ProceduresList the steps in order necessary to shut down and de-energize the equipment. Be specific. For stored energy, be specific about how the energy will be dissipated or restrained.

Procedure: __________________________________________________________________________________________________________________________________________________ Lock Type & Location: ________________________________________________________________________________________________________________________________________

How Will De-energized State Be Verified? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ NOTIFY ALL AFFECTED EMPLOYEES WHEN THIS PROCEDURE IS IN APPLICATION.

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The Control of Hazardous Energy (Lockout/Tagout) 2013

Start Up ProceduresList the steps in order necessary to reactivate (energize) the equipment. Be specific.

Procedure: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Energy Source Activated: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ NOTIFY ALL AFFECTED EMPLOYEES WHEN THIS PROCEDURE IS IN APPLICATION.

Procedures For Operations and Service/Maintenance

List those operations where the procedures above do not apply [See 29 CFR 1910.147 (a)(2)]. Alternate measures which provide effective protection must be developed for these operations. Job Safety Analysis is one method of determining appropriate measures.

Operation Name: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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The Control of Hazardous Energy (Lockout/Tagout) 2013

Affected and Authorized Employees

List each person affected by this procedure and those authorized to use this procedure.

AFFECTED EMPLOYEES

Name Job Title

AUTHORIZED EMPLOYEES

Name Job Title

_____________________________________________________________________________ Approved by Date

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