• Document No.

  • Site / Company

  • Conducted on

  • Prepared by

  • Personnel interviewed and accompanying auditor


  • Is there a written and approved site procedure for isolation and lockout?

  • Has it been communicated to the employees ?

  • Has it been communicated to the contractors?

Equipment to be isolated

  • Is it always assumed that all equipment listed is “live” and therefore must be isolated before any work is commenced?

  • Are responsible person attached a tag at each time isolation point?

  • Is electrical isolation co ducted only by appointed qualified competent person?

  • Is electrical isolation done by switching off the local main supply switch and locking it out?

  • Are all electrical and hydraulic equipment tested after isolation and before work commenced to ensure that all circuitry and lines are de-energized and that the equipment is actually inoperative and safe?


  • Is the a Engineering Manager appoint in writing permit issuers and identify the authorized permit holder and authorized isolator in the department?

  • Are Job Safety and environmental Analysis done before issued the permit?

  • Are all persons exposed to danger related to the work controlled by the permit personally sign on and off the permit?

  • Are permit or copy of the permit retained at the work site while work under the isolation permit is being carried out?

  • Is the permit holder and permit issuer close out the permit after the work had been completed?

  • Are copies of completed permits retained for a minimum period of 3 months by the maintenance secretary?

Isolating devices, locks and tags

  • Are individual locks supplied to all electricians ?

  • Is the list of lock numbers and employee names and ID number available and up to date?

  • Are the tags placed in a prominent position where they can be easily seen by anyone attempting to start, operate or access the plant or equipment?

  • Is an approved devices available that allows additional locks to be attached to the isolation point eg multi-lock, adaptor, scissor locks whenever required?

  • Do Ll people affected by the isolation being notified to ensure no safety or operational problems created?

  • Is personal danger tags and lockout lock placed on the appropriate isolation point/s by every individual person who would be endangered by restoration of the energy supply while work is in progress?

  • Are all isolations checked to verify the isolation has been effective?

  • Does each person remove his/herb own personal danger tag and lock?

Isolation points

  • Is there adequate number of isolation points on plant and equipment located with consideration for practicality, accessibility and identification ?

  • Are isolation devices clearly labeled o indicate that they are in the “on” or “ off” position?

Training and Assessment

  • Are all persons required to conduct isolation and lockout trained and assessed in general isolation practice?

Re-energizing when person who locked out is not available

  • When a piece of equipment or plant needs to be re-energized but the person who locked out is not available, the equipment is remain locked until the person who locked the equipment is located and able to remove the lockout

  • Does person break or open any lockout device in use received disciplinary action?

  • Is the procedure followed to remove a tag if for any reason an employee leaves the lease or is unfit to return to the lease without removing the tags?

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