Hazardous Energy Control (Lockout and Tagout) Checklist.

• Audit Title

• Squadron

• Conducted on

  Date

• Inspector

• Location
  Address

• Supervisor

21.9 Hazardous Energy Control (Lockout and Tagout) Checklist

• Are procedures developed and documented for safe and proper use of locks and tags? AFI 91-203 para. 21.2.1.4

  Yes

  No

  N/A

• Has a training plan been developed for initial and recurring training on lockout and tagout procedures? AFI 91-203 para. 21.2.1.6

  Yes

  No

  N/A

• Are LOTO devices (typically locks) used as a positive means of isolating energy sources and preventing unexpected start-up of machines and equipment? AFI 91-203 para. 21.2.1.7

  Yes

  No

  N/A

• Is an inspection of the lockout and tagout program conducted annually? AFI 91-203 para. 21.2.1.10

  Yes

  No

  N/A

• Is an adequate supply of safety tags and locks available for use? AFi 91-203 para. 21.3.3

  Yes

  No

  N/A

• Are all workers responsible for recognizing when LOTO is used, the general reasons for LOTO and the importance of not tampering with or removing LOTO devices? AFI 91-203 para. 21.3.4.1

  Yes

  No

  N/A

• Have equipment-specific, written procedures been developed for use when equipment or machinery undergoes servicing, modification or maintenance? AFI 91-203 para. 21.3.8

  Yes

  No

  N/A

• Are affected personnel in the area notified before and after lockout or tagout controls are used? AFI 91-203 para. 21.4

  Yes

  No

  N/A

• Does the supervisor, authorized worker and operator responsible for the equipment or machinery know the type, magnitude and hazards of the energy source(s)? AFI 91-203 para. 21.4.2.1.1

  Yes

  No

  N/A

• Are lockout devices attached in a manner that will hold the energy isolating devices in a―safe‖ or ―off‖ position? AFI 91-203 para. 21.4.2.5.1

  Yes

  No

  N/A

• Are service/administrative locks and tags replaced when maintenance on equipment and machinery starts? AFI 91-203 para. 21.4.9.1.3

  Yes

  No

  N/A

• Are specific, written procedures utilized during shift or personnel changes to ensure the continuity of lockout or tagout protection? AFI 91-203 para. 21.4.10

  Yes

  No

  N/A

• Is initial and recurring lockout and tagout program job training current and documented? AFI 91-203 para. 21.5.5

  Yes

  No

  N/A

• Are periodic self-inspections conducted and documented by the unit? AFI 91-203 para. 21.6.1

  Yes

  No

  N/A

• Report Routing

• Supervisor Signature:

  Sign

• Notification

  N/A

  Info

  Action

• Superintendent Signature:

  Sign

• Notification

  N/A

  Info

  Action

• Commander Signature:

  Sign

• Notification

  N/A

  Info

  Action

• Safety Office Signature:

  Sign

• Notification

  N/A

  Info

  Action

• Wing Commander Signature:

  Sign

• Notification

  N/A

  Info

  Action