Title Page

  • Site conducted

  • Conducted on

  • Auditor

  • Location


  • During audit

  • Shift Change Over: If lock box is being used: Was lock box handed over to the next shift by the previous shifts FLM and Work Group Safety Representative

  • If the answer is no contact FLM immediately.

  • Shift Change Over: Have line checks been completed to ensure all workers have locked onto lock box.

  • Review line walk and check currrent team members are locked onto lock box. If answer is NO contact Team-co.

  • Are standardized lock colors being used

  • Personal Danger Locks are colored Blue for Operations Workers + Red for Maintenance Workers

  • Where Out of Service Locks and Tags are being used is a Yellow Lock and Yellow Tag being used?

  • Do workers have direct access to Personal Danger Lock & Tag

  • Workers must have direct access to their Personal Lock and Tag at the workers work station, it is unacceptable for Locks and Tags to be in lockers or in a location outside direct work location.

  • Are there any Personal Danger Locks & Tags not removed from previous shift.

  • If answer in NO contact Front Line Manager

  • Are all keys removed from locks and placed in lock box.

  • Complete line walk checking locks ( personal locks, sanitation , maintenance.)

  • Add drawing

  • Are locks used in the control of hazardous energy identifiable to the person applying the lock

  • Add drawing

  • Are all locks stored on lock board blue and do they all have personal tags.

  • Add drawing

TAGS: warning against hazardous conditions. Are these tags identifiable to the person applying the tag,

  • Do not operate tags

  • ( A tag with red and black lettering on a white background and the wording "Danger Do Not Operate" The danger tag is for the protection of the person who applied it"

  • Out of Service Tag

  • ( A tag with black lettering on a yellow background and the wording "Caution, Out of Service" The out of service tag is used to identify equipment that is faulty or out of service )

  • Do not start

  • Commissioning tags.

  • Add drawing

Energy control devices. (Used to secure the control in the desired position, and capable of accepting a lock and /or tag)

  • Valve Covers

  • Add drawing

  • Handle Covers

  • Add drawing

  • Circuit Breaker Covers

  • Add drawing

  • HASP

  • Add drawing

  • Blocks and chains (used to secure residual or stored energy from release)


  • Add signature


  • When audit has been completed , please select yes to submit.

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