Title Page

  • LOTO Program Assessment

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Are procedures developed and documented for safe and proper use of locks and tags? Reference 21.2.1.4

  • Has a training plan been developed for initial and recurring training on lockout and tagout procedures? Reference 21.2.1.6

  • Are LOTO devices (typically locks) used as a positive means of isolating energy sources and preventing unexpected start-up of machines and equipment? Reference 21.2.1.7

  • Is an inspection of the lockout and tagout program conducted annually? Reference 21.2.1.10

  • Is an adequate supply of safety tags and locks available for use, including the AF Form 983 and administrative locks? Reference 21.3.3

  • Are all workers responsible for recognizing when LOTO is used, the general reasons for LOTO and the importance of not tampering with or removing LOTO devices? Reference 21.3.4.1

  • Have equipment-specific, written procedures been developed for use when equipment or machinery undergoes servicing, modification or maintenance? Reference 21.3.8<br>

  • Are affected personnel in the area notified before and after lockout or tagout controls are used? Reference 21.4

  • Does the supervisor, authorized worker and operator responsible for the equipment or machinery know the type, magnitude and hazards of the energy source(s)? Reference 21.4.2.1.1

  • Are lockout devices attached in a manner that will hold the energy isolating devices in a ―safe‖ or ―off‖ position? Reference 21.4.2.5.

  • Are service/administrative locks and tags replaced when maintenance on equipment and machinery starts? Reference 21.4.9.1.3

  • Are specific, written procedures utilized during shift or personnel changes to ensure the continuity of lockout or tagout protection? Reference 21.4.10

  • Is initial and recurring lockout and tagout program job training current and documented? Reference 21.5.5

  • Are periodic self-inspections conducted and documented by the unit? Reference 21.6.1

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