FMSO Lock out / Tag out / Try out Process Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Names of Auditors

Lockout Details

• List equipment locked out.

• Employee Name:

• LOTOTO Experience:

• Work Experience:

LOTOTO Audit

• Is there a designated Energy Control Coordinator?

  Yes

  No

  N/A

• Is the ECC the most qualified person of the work group?

  Yes

  No

  N/A

• Has the affected individual or ECC performed a try-out?

  Yes

  No

  N/A

• Is an ECC form or ECC log book used in this lock-out?

  Yes

  No

  N/A

• Does the ECC have a personal lock on the lock box?

  Yes

  No

  N/A

• Is there a label on the lock box for the equipment that is locked out?

  Yes

  No

  N/A

• Do the other locks have personal tags with name, date, equipment name and reason for lock-out?

  Yes

  No

  N/A

• How many are compliant? How many are not compliant?

• Are the tags correctly labeled as Do Not Operate, ECC, or Personal?

  Yes

  No

  N/A

• Are first and last names printed on the tags?

  Yes

  No

  N/A

• Are there other affected individuals on this task?

  Yes

  No

  N/A

• Number of employees:

• Does the number of people match the number of locks?

  Yes

  No

  N/A

• Number of locks:

• Are all the locks colored, plastic bodied safety locks?

  Yes

  No

  N/A

• Safety locks?

• Is the lockbox located by the E-House or equipment?

  Yes

  No

  N/A

• Location of lockbox?

• Are there keys in the lockbox?

  Yes

  No

  N/A

• Number of keys in the lockbox?

• Does the number of keys coincide with the number of equipment pieces that are isolated?

  Yes

  No

  N/A

• Has everyone received LOTOTO or LOTOTO for ECC training?

  Yes

  No

  N/A

• # of LOTOTO; # of LOTOTO for ECC;

Following the audit, locate the ECC and discuss the above items with him/her.

• Does the ECC understand that he has total responsibility of the energy isolation?

  Yes

  No

  N/A

• How does he/she demonstrate it?

• Address the ECC and other individuals using a One Minute Manager discussion.

• One Minute Manager comments:

Lock out / Tag out / Try out Knowledge Survey

• 1 - No Knowledge 2 - Limited Knowledge. 3 - Moderate Knowledge. 4 - Competent. 5 - Expert.

• What is a zero tolerance rule, and why is LOTOTO a ZTR?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• ANSWER: Rule if broken can cause serious injury or death. Yes discipline a big possibility, but safety is a bigger deterrent.

• Has everyone received LOTOTO training?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• What is the main purpose of the Energy Control Policy?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• ANSWER: To prevent injury and save lives by preventing human contact with unexpected or unrestrained energy.

• Define affected individual (AI)? Qualified individual (QI)? ECC?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• ANSWER: Person who (AI) could be exposed to energy. (QI) Is familiar with equipment, knows hazards, isolation, zero energy state, can be plumber, operator, mechanic, electrician, etc. ECC is the most qualified person having technical and working knowledge of the equipment being isolated and is chosen work by group for each specific job, has overall responsibility to ensure energy isolation and for LOTOTO.

• Why must affected individuals place or witness the placement of their locks on the energy isolating device?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• ANSWER: To ensure the energy control of the proper equipment.

• What situations require an ECC?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: When multiple crafts are working on common equipment, or due to high number of employees, it is practical to have a lock box and one person assume responsibility for try out. The same can apply to multiple employees from the same group.

• What is the purpose of tryout and who is responsible to perform it?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: To ensure zero energy state and verify the correct equipment was de-energized, (QI) performs it, (ECC & AI) ensures it has been done.

• How does the ECC form help the affected employees and the ECC?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: Affected employee can review what equipment is locked out, it is a record of try out, who and how many employees have locked out, it helps identify who ECC & AI are, identify who continues to have equipment locked out and who has released equipment. It can also be used to compare number of locks to names.

• What locks and tags go on the lock box?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: All (AI) personal locks. the ECC personal lock on the box should have an ECC and Personal tag. ECC locks go on the isolated equipment.

• Define the tags allowed in the energy control policy?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: Personal - to identify each affected person. ECC - total energy control responsibility. Out of service - protect equipment, no hazards or waiting for parts. Name, Date, equipment ID, and task being performed legibly and in permanent ink.

• Why is it important to use the right tag?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: Must be able to identify the ECC. An out of service tag does not indicate a LOTOTO condition and increases possibility of re-energizing.

• What do you do if the tag is filled from previous use?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: You can get another tag or you can use the adhesive labels to write on.

• How does auditing the locks on the lock box ensure safety?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: It helps you identify lockbox and verify corresponding task, it could ensure accountability - 4 guys on a Job = 4 locks on box.

• Who maintains possession of keys to personal locks and why? ECC locks?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: Personal lock keys stay with owner at all times to give employee absolute energy control. The ECC lock stays in lockbox until each personal lock is removed off box, including ECC's personal lock. ECC responsibilities can be transferred using proper procedures, the lock box can transfer to oncoming shift, but the key stays in lock box until LOTOTO condition is terminated.

• How do you know what task the lock box belongs to?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: review the ECC form or label on lock box, review other tags on lock box, contact ECC or supervisor.

• Describe the steps of a non- routine lock removal?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: (Inform area superintendent of any action.) Supervisor: ID lock owner, contact owner, owner grants permission, inspect equipment, remove lock. If lock owner can't be identified or contacted, a qualified individual, safety rep, area supervisor and ECC ( if used) shall make a thorough inspection. Management (exempt employee) will cut lock if equipment is safe to operate.

• As the affected individual, how do you terminate a LOTOTO? As the ECC?

  No Knowledge

  Limited Knowledge

  Moderate Knowledge

  Competent

  Expert

• Comments

• ANSWER: Locks shall be removed if the individual is assigned to another Job, leaves at the end of shift or work is completed, unless this exposes others to a hazard. (AI) shall remove or witness the removal of their lock and tag. Annotate on ECC form if used. A qualified individual removes the lock and tag from isolating device. (AI) shall verify lock removal and the equipment is safe to operate. (QI) re-energizes. (AI) notifies operations, ECC performs same steps with responsibility for all.

• Auditor(s) Signature

  Sign

• Revision 1.0 iCloud posted document is the controlled copy. 07/08/13