To be submitted when a valve is changed or a seal is broken.

Lockout/Tagout applies to the service and maintenance of machines and equipment, including piping systems, if employees could be injured by the unexpected energization or start up of the machine or equipment or release of stored energy. Energy sources include mechanical, hydraulic, pneumatic, chemical, thermal, or other energy, including gravity. Machines and equipment include those that produce high intensity electromagnetic fields.

ASME A17.1 requires periodic tests on various types of elevator equipment. This form is used as documentation to test hydraulic elevators.