Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Uncontrolled Energy Release Critical Controls
• Access control & permit
• Isolation, Lockout, Tagout & Verification
• Energy release devices
• Securing & blocking devices
• Guards & barriers
• Confirm zero energy -
Select date
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Discuss: What are the stored energy hazards in the task and surrounding area?
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Discuss: What are the Critical Controls for uncontrolled release of energy?
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Were the critical risks and controls discussed during your toolbox meeting?
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Are exclusion zones and barricading set up to protect external personnel from exposure to uncontrolled release of energy?
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Has an Isolation, Lockout and Verification process been followed?<br>
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Are Isolation, Lockout and Verification hazards documented on the associated safe method of work?
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Are verification steps being completed to ensure zero energy state?
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Is the correct PPE being used for the task?
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Where being used, do flexible hoses have tags that confirm they are within test date and are in appropriate physical condition for the task?
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Is equipment fit for purpose?
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Have surrounding areas been checked for stored energy hazards?
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Were gaps identified during the field verification today?
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What actions were taken to close those gaps, by who, by when?
