**Lock & Tag Logsheet**

<table>
<colgroup>
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 23%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><strong>Tag Number</strong></td>
<td rowspan="2"><strong>Work Document</strong></td>
<td rowspan="2"><strong>Building/Room</strong></td>
<td rowspan="2"><strong>Equipment/Component Position and Reason
Installed</strong></td>
<td rowspan="2"><strong>Date Installed</strong></td>
<td rowspan="2"><p><strong>Authorized/</strong></p>
<p><strong>Installation By</strong></p></td>
<td rowspan="2"><strong>Date Removed</strong></td>
<td rowspan="2"><p><strong>Authorized/</strong></p>
<p><strong>Removed By</strong></p></td>
<td colspan="4"><strong>Annual Inspection Date/Initial</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td rowspan="4"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="4"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="4"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="4"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="4"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td></td>
</tr>
</tbody>
</table>