• Document No.

  • Work Order number:

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Technician

  • Work Order Completion Date:

Lockout /Tagout Procedures

  • Is LOTO required?

  • Has LOTO procedures been reviewed with by employees?

  • Are all LOTO isolation points identified?

  • Have the energy dissipation been verified?

  • Have LOTO measures been implemented effectively?

Work Order Information

  • Did the contractor show up when expected or call 24 hrs in advance to reschedule?

  • Did the contractor check in and out with the site personnel?

  • Did the contractor have an approved defined scope of work or task list with them that they are working off of?

  • Did the contractor wear the appropriate PPE while performing the work?

  • Did the contractor complete the work per the approved design / scope of work / PM?

  • If a piece of equipment was a part of the work, is the unit free of leaks (oil, water, gas), in operating condition and clean?

  • Are comments clearly written including additional deficiencies and follow up work order numbers?

  • Was appropriate time charged to the work order?

  • Did the contractor properly fill out and leave an adequate service report?

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