Information
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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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This annual LOTO audit shall be conducted by an authorized, trained employee who does not participate in the lockout process being audited. This audit must be conducted as the lockout procedure is being implemented. Any deficiency found in the LOTO procedure must be corrected immediately and all authorized employees must be re-trained on that LOTO procedure. If a situation is discovered to be immediately dangerous to life or health, the LOTO process must be terminated.
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Select date
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Department
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Person Completing Audit
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Equipment Name
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LOTO PROCEDURE AUDIT QUESTIONS
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Has the employee completed initial Authorized Employee LOTO training?
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Has the Authorized Employee competed LOTO training for the equipment specific LOTO procedure(s)?
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Has there been a change in job assignment, machines, equipment, or processes that present a new hazard requiring retraining of Authorized Employee?
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Are the Authorized Employee's training records available for review?
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Is a LOTO procedure available for this piece of equipment?
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Is an equipment specific LOTO procedure required for this piece of equipment?
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Did the Authorized Employee know the location of the LOTO procedure?
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Does the written LOTO procedure list and describe the known energy sources?
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Does the written LOTO procedure include procedural steps for de-energizing and controlling all identified potential hazardous energy?
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Were all affected employees properly notified before servicing the piece of equipment?
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Did the authorized Employee identify and locate all energy sources?
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Did the Authorized Employee use the appropriate LOTO locks, tags, and devices?
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Did the LOTO device contain written, legible information identifying the Authorized Employee?
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Did the Authorized Employee attempt to start-up the piece of equipment to test the LOTO procedures before conducting work?
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Did the Authorized Employee return the controls to the off position after verifying the isolation and de-energization of the piece of equipment?
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If more than one authorized employee working on the piece of equipment, did each employee have his/her own lock and tag?
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Did the Authorized Employee follow the appropriate procedures for LOTO removal and re-energizing the piece of equipment?
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Authorized Employee's Signature
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Auditor's Signature
