CHES Lockout Tagout Audit Checklist

• Clean Harbors Lockout Tagout Audit

• Facility / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• In accordance with Code of Federal Title 29 Section 1910.147 CHES conducts periodic audits of Lock Out /Tag Out procedures being performed at CHES locations. These audits shall identify the machinery or equipment on which the energy control procedures are being utilized, the date of the audit, identification of the employees involved in the inspection and the person performing the inspection.

• Pull the existing completed LO/TO permits, training records, associated documentation and review them for content and accuracy

• Are “authorized employees” identified in writing?

  Yes

  No

  N/A

• Have authorized employees received documented training in the recognition of hazardous energy sources, the type and magnitude of the energy available and methods and means necessary for energy isolation and control?

  Yes

  No

  N/A

• Have “affected employees” received documented training on this procedure and regarding the prohibition relating to attempts to restart or reenergize equipment that is locked or tagged out?

  Yes

  No

  N/A

• Are completed permits maintained on file? If so, where (comments)?

  Yes

  No

  N/A

• Are all permits on file closed and signed off on prior to filing?

  Yes

  No

  N/A

• Are control points identified on the permits?

  Yes

  No

  N/A

• Have all permits been signed by all affected personnel?

  Yes

  No

  N/A

• Have all personnel potentially exposed to electrical hazards received documented safety training in accordance with 1910.331-335?

  Yes

  No

  N/A

• Conduct interviews of the Maintenance Manager, Operations Managers, Operations Foremen/Supervisor, and at least one maintenance employee and one facility tech that is identified as being an authorized or affected employee

• Do authorized employees recognize hazardous energy sources, types, the magnitude of the energy available and methods and means necessary for energy isolation and control?

  Yes

  No

  N/A

• Have affected employees been provided the opportunity to review and understand the CHES Lock Out/Tag Out Program?

  Yes

  No

  N/A

• Do all employees understand where to find designated lock out/tag out equipment?

  Yes

  No

  N/A

• Do all “affected personnel” potentially exposed to hazardous energy sources understand that they may not share keys for individual locks under any circumstances?

  Yes

  No

  N/A

• Where tags are permitted, do personnel understand that tags are only warning devices and do not physically prevent the operation of the equipment?

  Yes

  No

  N/A

• Do personnel understand that LO/TO locks and tags are not to be removed without authorization?

  Yes

  No

  N/A

• Do personnel understand that LO/TO locks and tags are never to be by-passed, ignored, or otherwise defeated?

  Yes

  No

  N/A

• Does each authorized and affected employee understand that they must have individual control over a lock out situation?

  Yes

  No

  N/A

Group Lock Box

• Where is it Used?

• Name of the Department using the item

Padlocks

• Where is it Used?

• Name of the Department using the item

Tags (Do Not Operate, Danger, etc;)

• Where is it Used?

• Name of the Department using the item

Chains

• Where is it Used?

• Name of the Department using the item

Wedges

• Where is it Used?

• Name of the Department using the item

Key Blocks

• Where is it Used?

• Name of the Department using the item

Adapter Pins

• Where is it Used?

• Name of the Department using the item

Self-Locking Fasteners

• Name of the Department using the item

• Where is it Used?

Breaker Blocks

• Where is it Used?

• Name of the Department using the item

Circuit Breaker Covers

• Where is it Used?

• Name of the Department using the item

Gate Valve

• Where is it Used?

• Name of the Department using the item

Ball Valve

• Where is it Used?

• Name of the Department using the item

Wall Switch

• Where is it Used?

• Name of the Department using the item

• Equipment: Identify the equipment that is locked and/or tagged out:

Equipment

• Equipment

• Location

• Energy Source

  Select Electrical Hydraulic Thermal Potential

  • Electrical
  • Hydraulic
  • Thermal
  • Potential

• Hazard Severity

  Severe

  Moderate

  Negiligible

• Number of LOTO Points

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Estimated Frequency of LOTO

  Daily

  Weekly

  Monthly

  Quarterly

  Annually

• Existing Hazard Sign(s)

• Where tags are used, are the tags legible and understandable by all employees?

  Yes

  No

  N/A

• Are the tags made of material that will withstand the environmental conditions encountered in the workplace?

  Yes

  No

  N/A

• Are tags securely attached to the energy-isolating device?

  Yes

  No

  N/A

• Can the unit be locked out?

  Yes

  No

  N/A

• Is the point of operation, nip flying objects, chips, sparks, etc. contained?

  Yes

  No

  N/A

• Are employees protected from flying objects, chips, sparks, etc?

  Yes

  No

  N/A

• Are guards in place that are designed to prevent employee from having body in danger zone during the operation cycle?

  Yes

  No

  N/A

• Is the machine securely anchored to prevent walking or moving?

  Yes

  No

  N/A

• I certify that the above audit was performed in accordance with 29 CFR 1910.147

• Report Prepared By:

• Date

  Date

• Reviewed BY:

• Date

  Date