Information
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Conducted on
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Prepared by
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Team member
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Employee number
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Equipment Location
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Equipment Description
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Shift
Preparing for shutdown audit items:
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Has the team member(s) been trained in the general lockout/tagout procedure?
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Does each team member have personal locks and tags available for use?
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Are the hazardous energy control procedures available in the work area?
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Are disconnects/switches permanently labeled?
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The team member was able to identify all energy sources for the equipment involved?
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The team member notified all affected team members in the area?
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Is the LO/TO procedure being followed appropriately?
Shutting down the equipment audit items:
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Did the team member shut down all equipment involved using normal stopping/shutdown procedures (e.g., putting a disconnect/switch in the "off" position or pressing a stop button)?
Isolating the equipment audit items:
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Was the equipment isolated from every energy source feeding into it (e.g., close valves, shut off main disconnects, shut off circuit breakers)?
Applying lockout/tagout devices audit items:
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Were the appropriate locks, tags, and lockout devices available and utilized?
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Did all team members involved use their own appropriate locks and tags?
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If more than one team member was involved in the process, did all team members put their lock/tag on the equipment?
Rendering safe all energy audit items:
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Was all potential residual hazardous energy relieved, disconnected, or restrained (e.g., mechanical, hydraulic, air, etc.)?
Verification of isolation audit items:
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Was equipment tested to ensure the right system(s) we're locked out and to ensure that the equipment could not be operated (e.g., push start buttons, turn on disconnects, etc.)?
Releasing equipment from LOTO audit items:
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All tools and equipment have been removed from the area?
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All equipment components are intact and capable of operating properly(e.g., machine guards are in place, etc.)?
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Were all personal lockout/tagout devices removed by the team member who applied them?
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Were all affected team members notified that locks and tags were removed and the equipment is ready for use?
Problems:
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List any problems identified during the audit:
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Photos
Resolutions to problems identified:
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List corrective actions taken to rectify the problems listed above to include acceptable correction dates:
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Follow ups
Signatures:
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Team member's signature:
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Auditor's signature:
