Hazardous Energy Control (Lockout and Tagout) Checklist.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

21.9 Hazardous Energy Control (Lockout and Tagout) Checklist.

• 21.9.1. Are procedures developed and documented for safe and proper use of locks and tags?<br>Reference 21.2.1.4

  Yes

  No

  N/A

• 21.9.2. Has a training plan been developed for initial and recurring training on lockout and tagout<br>procedures? Reference 21.2.1.6

  Yes

  No

  N/A

• 21.9.3. Are LOTO devices (typically locks) used as a positive means of isolating energy sources and<br>preventing unexpected start-up of machines and equipment? Reference 21.2.1.7

  Yes

  No

  N/A

• 21.9.4. Is an inspection of the lockout and tagout program conducted annually? Reference 21.2.1.10

  Yes

  No

  N/A

• 21.9.5. Is an adequate supply of safety tags and locks available for use? Reference 21.3.3

  Yes

  No

  N/A

• 21.9.6. Are all workers responsible for recognizing when LOTO is used, the general reasons for<br>LOTO and the importance of not tampering with or removing LOTO devices? Reference 21.3.4.1

  Yes

  No

  N/A

• 21.9.7. Have equipment-specific, written procedures been developed for use when equipment or<br>machinery undergoes servicing, modification or maintenance? Reference 21.3.8

  Yes

  No

  N/A

• 21.9.8. Are affected personnel in the area notified before and after lockout or tagout controls are<br>used? Reference 21.4

  Yes

  No

  N/A

• 21.9.9. Does the supervisor, authorized worker and operator responsible for the equipment or<br>machinery know the type, magnitude and hazards of the energy source(s)? Reference 21.4.2.1.1

  Yes

  No

  N/A

• 21.9.10. Are lockout devices attached in a manner that will hold the energy isolating devices in a<br>―safe‖ or ―off‖ position? Reference 21.4.2.5.1

  Yes

  No

  N/A

• 21.9.11. Are service/administrative locks and tags replaced when maintenance on equipment and<br>machinery starts? Reference 21.4.9.1.3

  Yes

  No

  N/A

• 21.9.12. Are specific, written procedures utilized during shift or personnel changes to ensure the<br>continuity of lockout or tagout protection? Reference 21.4.10

  Yes

  No

  N/A

• 21.9.13. Is initial and recurring lockout and tagout program job training current and documented?<br>Reference 21.5.5

  Yes

  No

  N/A

• 21.9.14. Are periodic self-inspections conducted and documented by the unit? Reference 21.6.1

  Yes

  No

  N/A