(I)
(J)
(K)
officer and the repair activity representative,
if applicable, certify the work completed
and the tags cleared by signing and dating in
the blocks provided.
TAG NO. (back side of form): List each
tag separately. An example tag number is
“76-3. ” The “76” is the issue log serial
number. The “-3” indicates that the tag is the
third one used.
LOCATION: Be specific. Give the power
panel identification number and breaker
identification number. If the tag-out action is
on board a ship or submarine, also give the
frame number. If the action is ashore, also give
the building and room number.
TAGGED POSITION/CONDITION: State
the position in which the tagged item should
remain (examples; ON, OFF, OPEN, or
(L)
(M)
(N)
CLOSED).
POSTED BY (INITIAL): The person who
actually hangs the tag, initials here.
POSTING CHECKED BY: A second person,
after checking to make sure the tag was
attached correctly, initials here.
CLEARANCE/POSITION/CONDITION:
State the position each tagged item should be in
when the tag is cleared.
(O)
(P)
(Q)
(R)
CLEARANCE AUTHORIZED: After you’ve
completed the work, the authorizing officer
and the outside repair activity authorize you,
by signing here, to clear the tags.
DATE/TIME CLEARED: The person who
removes the tag enters the date and time the tag
is removed.
CLEARED BY: The person who removes the
tag initials here.
SIGNATURE OF WATCH OFFICER/DUTY
OFFICER and DATE/TIME: The authorizing
officer signs and dates the form here to certify
that all switches, circuit breakers, etc., are
returned to their normal operating position/
condition.
Section 4: Instrument Log (NAVSHIPS 9890/10).
This log is the record of all of the out-of-commission
and out-of-calibration labels issued.
Section 5: DANGER/CAUTION Tag-out Record
Sheets that have been cleared and are no longer in
effect.
CAUTION Tags (NAVSHIPS 9890/5)
A CAUTION tag is a yellow-colored tag used only
as a precautionary measure to give temporary special
instructions, or to indicate that unusual caution must be
exercised when operating the equipment to which the
tag is attached (fig. 3-6).
Figure 3-6.—CAUTION Tag (yellow in color).
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