DHM - OSHA LOTO Inspection Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Energy Control Program

• Your company has an energy control program that prohibits service or maintenance on powered equipment unless energy has been drained and lockout/tag out procedures performed.<br><br>

  Yes

  No

  N/A

• All locations requiring lockout/tagout are identified

  Yes

  No

  N/A

• Specific lockout/tagout procedures have been developed.

  Yes

  No

  N/A

• Lockout/tagout procedures are reviewed at least annually.

  Yes

  No

  N/A

• Only trained/authorized employees perform lockout and remove locks or tags.

  Yes

  No

  N/A

Locks and Tags

Locks are:

• Standardized throughout the facility.

  Yes

  No

  N/A

• Strong enough to withstand all but heavy force or tools.

  Yes

  No

  N/A

• Durable enough for conditions where they're used.

  Yes

  No

  N/A

• Used only for lockout.

  Yes

  No

  N/A

• Identified with name of authorized employee who installs and removes them.

  Yes

  No

  N/A

Tags are:

• Used only when equipment can't be locked out.

  Yes

  No

  N/A

• Understood to be warning only.

  Yes

  No

  N/A

• Used for this purpose only

  Yes

  No

  N/A

• Strong and durable

  Yes

  No

  N/A

• Marked with bold, easy-to-read warnings

  Yes

  No

  N/A

• Identified, when used, with the name of the authorized employee who installs and removes them.

  Yes

  No

  N/A

Employee Training

Documentation of employee training has been completed for all:

• Authorized employees

  Yes

  No

  N/A

• Affected employees

  Yes

  No

  N/A

• Other employees

  Yes

  No

  N/A

Authorized Employees have been trained and know:

• Type and amount of energy their machines and equipment use

  Yes

  No

  N/A

• How to control machine and equipment enrgy

  Yes

  No

  N/A

• Specific lockout/tagout procedures

  Yes

  No

  N/A

Affected employees have been trained and know:

• Why energy control procedures are important and required

  Yes

  No

  N/A

• Never to try to start locked or tagged equipment.

  Yes

  No

  N/A

• Never to remove, ignore, or bypass locks and tags.

  Yes

  No

  N/A

Other employees have been trained and know:

• Never to try to start locked or tagged equipment.

  Yes

  No

  N/A

• Never to remove, ignore, or bypass locks and tags.

  Yes

  No

  N/A

Lockout Procedures are performed by authorized employees in this sequence:

• Identify machine energy type, it's hazards, and control devices.

  Yes

  No

  N/A

• Inform affected employees of planned lockout.

  Yes

  No

  N/A

• Determine who has primary responsibility if service/maintenance is a group assignment.

  Yes

  No

  N/A

• Turn off machine or equipment.

  Yes

  No

  N/A

• Locate and isolate all energy sources; get rid of stored energy.

  Yes

  No

  N/A

• Lockout energy controls (all members attach own locks during group service work).

  Yes

  No

  N/A

• Test operating controls, then return to "off" position.

  Yes

  No

  N/A

• Perform service/maintenance.

  Yes

  No

  N/A

• If energizing to test or position equipment, follow lockout removal steps.

  Yes

  No

  N/A

• Repeat lockout steps after test/repositioning.

  Yes

  No

  N/A

• Before re-energizing, removing tools and be sure employees are safely away from equipment.

  Yes

  No

  N/A

• Reinstall machine guards.

  Yes

  No

  N/A

• Remove lockout devices

  Yes

  No

  N/A

• Turn on energy and notify other employees.

  Yes

  No

  N/A