Title Page
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Conducted on
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Prepared by
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Location (Cell Number)
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Machine (CL) Number
Part 1 - Equipment being worked upon at the time of the inspection
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Is a maintenance technician or contractor working on the machine at this time?
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Is the equipment clearly locked out, with the correct RED LOTO padlocks, hasps and identification tags on each source of hazardous energy?
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Is the work area clearly and securely protected by barriers, tapes and signs to prevent unauthorised entry?
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Please take photos of the work area, whether barriered off or not
Part 2 - Equipment-Specific Lockout Procedure
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Can the technician / contractor identify the equipment-specific lockout procedure?
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Why not?
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Do the hazardous energy sources match those identified in the equipment-specific lockout procedure? (get the technician / contractor to demonstrate for you)
Part 3 - Demonstration of Lockout in Action
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Is the person performing maintenance tasks a contractor?
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Was Lockout applied by an MB Aerospace authorised employee with the contractor present?
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The LOTO procedure requires that Lockout is applied by an MB Aerospace authorised person and carried out with the contractor present; the verification steps should then be taken and BOTH apply their locks and tags
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Why was an MB Aerospace technician not present while Lockout was applied?
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Was the equipment locked out in accordance with the procedure?
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Can the MB Aerospace technician / contractor demonstrate / explain the verification steps?
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Ask the technician / contractor to show you the Lockout key(s) - they should have one key per Lockout padlock, on their person at all times - especially if leaving the equipment unattended for any length of time
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Has the technician / contractor got the key(s) available for examination?
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If the answer is NO - where are the key(s)?
Part 4 - Lock
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Is the lock(s) used an MB Aerospace-issued red lock, applied with a hasp and correct ID Tag?
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If not, why not?
Part 5 - Equipment Return To Service
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IF the equipment is ready to be returned to operational service, are machine guards & safety devices replaced?
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Have they been positively checked for correct function, before handing back?
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Are all other employees in a safe zone, well away from the machine at first start-up?
Part 6 - Comments & Findings
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Are there any comments you wish to make from your findings?
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Are there any corrective actions required, to ensure safety of employees & contractors?
Signatures
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Name of person(s) performing maintenance operation:
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Name of person completing this inspection:
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Maintenance supervisor / manager