Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Personnel interviewed and accompanying auditor
Procedure
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Is there a written and approved site procedure for isolation and lockout?
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Has it been communicated to the employees and contractors?
Permits
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Has a permit to work been obtained prior to commencing work!
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Has a risk assessment been conducted and approved?
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Has the Maintenace Manager appointed in writing competent persons as isolation and lockout permit issuers?
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Has an isolation and lockout permit been issued prior to commencement of work and is this readily available?
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Have employees required to conduct lock out and tag out been trained?
Isolation
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Are danger tags and locks used for lockout?
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Does the electrician do the primary lockout and indicate with a personal danger tag what equipment has been locked out?
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Has every employee required to work on the isolated equipment been issued with a lock (either a personal lock or a lock issued on a list with the permit with name and number of the lock and signature)?
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Has every employee working on the equipment locked out?
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Are personal locks removed when workers leave the work site even if the work is not yet completed?
Discipline
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Is disciplinary action taken when somebody destroys or removes a lock that is not theirs?
