Hazardous Energy (LOTO) Compliance Check

• Site conducted

  Select

• Conducted on

  Date

• Auditor

• Location

Locks:

• 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

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

• If answer in NO contact Front Line Manager

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

  Yes

  No

  N/A

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

• Add drawing

  Drawing

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

  Yes

  No

  N/A

• Add drawing

  Drawing

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

  Yes

  No

  N/A

• Add drawing

  Drawing

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

• Do not operate tags

  Yes

  No

  N/A

• ( 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"

  Drawing

• Out of Service Tag

  Yes

  No

  N/A

• ( 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 )

  Drawing

• Do not start

  Yes

  No

  N/A

• Commissioning tags.

  Yes

  No

  N/A

• Add drawing

  Drawing

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

• Valve Covers

  Yes

  No

  N/A

• Add drawing

  Drawing

• Handle Covers

  Yes

  No

  N/A

• Add drawing

  Drawing

• Circuit Breaker Covers

  Yes

  No

  N/A

• Add drawing

  Drawing

• HASP

  Yes

  No

  N/A

• Add drawing

  Drawing

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

  Yes

  No

  N/A

AUDITORS SIGNATURE

• Add signature

  Sign

AUDIT COMPLETION

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

  Yes

  No

  N/A