Title Page

  • Company

  • Audit Location
  • Name of Competent Person/s on Site

  • Date

  • Name of Person/s Conducting the Audit

  • INSTRUCTIONS

    1. Verify LOTO compliance by answering the questions accordingly
    2. Add Photos in "Images" and Comments in "Notes" on each question.
    3. Add a Corrective Measure in "Action." Provide a description, assign to a member, set priority, and due date
    4. Complete the audit by providing a digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

CRH / AMAT lock-out/tag-out policy (revised 2018)

  • 1. CRH / AMAT lock-out/tag-out policy (revised 2018) has been implemented and is posted or accessible to all employees at this site.

  • 2. Machine specific lock-out/tag-out procedures or isolation rules are in place. Accessible to all employees.

  • 3. Sufficient numbers of locks, tags, hasps, other LOTO devices, etc on site to conduct all anticipated maintenance activities. Accessible to all authorized employees.

  • 4. All authorized or affected employees have been trained in the lock-out/tag-out or isolation policy, as required by their level of exposure, and this training documented?

  • 5. Facility meets the requirement that locks can only be attached when the Isolator (lockout device) is in the locked position as outlined in Randy Lake's directive from Sept 2017 (i.e. Tarmac fatality and response)

  • 6. Pre-start warning alarms are fitted to conveyor systems as outlined in Randy Lake's directive from Sept 2017

CRH / AMAT Lock-out/Tag-out Policy

  • 7. There is an Authorized List of employees and the equipment they are trained and authorized on per CRH / AMAT lock-out/tag-out policy (revised 2018)

  • 8. A list of Close Proximity Maintenance (CPM) procedures specific to your facility has been created, if applicable?

  • 9. If CPM is used, a Job Safety Analysis (JSA) has been created outlining the planned step by step procedure?

  • 10. Change Management requirements around LOTO have been communicated to all authorized employees as outlined in Addendum 1 of the CRH / AMAT LOTO policy (revised 2018)

  • 11. Issues 1, 2 & 3 as outlined in Addendum 1 of the CRH / AMAT LOTO policy (revised 2018), have been communicated to contractors whose work involves LOTO

Electrical Safety - NFPA 70E

  • 12. Has an arc flash survey been completed by a qualified person for this facility with all elements fully implemented & completed (arc flash study, labeling, training, etc.)?

  • 13. All electrical work is performed by a qualified electrical person as outlined in the CRH / AMAT LOTO policy (revised 2018) and the AMAT South Division Electrical Safety Policy

  • 14. All qualified and/or affected employees wear appropriate arc rated PPE during electrical tasks? Arc flash PPE is in good condition and gloves are current?

  • 15. All electrically qualified persons have access to a voltage tester for verification of electrical deenergization before performing any electrical work tasks?

LOTO Annual Integrity

  • 16. All LOTO authorized employees are observed at least annually by a competent person who watches them conduct a task involving lock-out/tag-out or isolation to ensure that the system is operated as per rules, and this is documented.

  • 17. Have all machine specific procedures been inspected at least annually for correctness and to ensure equipment additions and changes have been implemented, and this inspection is documented?

  • 18. Issues 1, 2 & 3 as outlined in Addendum 1 of the CRH / AMAT LOTO policy (revised 2018), have been communicated to contractors whose work involves LOTO

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