Lock Out - Tag Out (LOTO) Audit

• Department

  Select

• Type of Lock Out:

• Date:

  Date

• Lock Out Done by:

• Sinagture

  Sign

• Process/ Task/ Machine:

• undefined

COMPLIANCE ACHIEVED

• 1. Is the Lock out procedure available and understood by staff?

  Yes

  No

  N/A

• 1.1. Verify by asking questions

  Safe

  At Risk

  N/A

• 2. Are "Lock Out" tags and locks and/or "Out of Service" tags in use?

  Yes

  No

  N/A

• 3. Are "Lock Out" tags and locks and/or "Out of Service" tags filled out correctly?

  Yes

  No

  N/A

• 4. Are spare “Lock Out” tags and “Out of Service” tags readily available?

  Yes

  No

  N/A

• 5. Do all employees use “Lock Out” tags and “Out of Service” tags correctly?

  Yes

  No

  N/A

• 6. Are lock out locks, scissors and tags being used for all isolations?

  Yes

  No

  N/A

• 7. Are all isolation devices labelled?

  Yes

  No

  N/A

• 8. Are keys removed from the lock out locks whilst personnel are working on the equipment?

  Yes

  No

  N/A

• 9. Is there a copy of the "Lockout/Tagout Quick Reference Guide" available on site? ( One Plan Lesson)

  Yes

  No

  N/A

• 10. Are all personnel and operators who is required to lock out, trained?

  Yes

  No

  N/A

• 11. Are all machinery or equipment capable of movement, required to be de-energized or disengaged and locked-out during <br> cleaning, servicing, adjusting or setting up operations, whenever required? (CAN IT BE LOCKED OUT? place to attach locks,etc.)

  Yes

  No

  N/A

• 12. Does the lockout procedure require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment <br> is locked-out for repairs?

  Yes

  No

  N/A

• 13. Are employees required to keep personal control of their key(s) while they have safety locks in use?

  Yes

  No

  N/A

• 13.1 Is a register available and up to date?

  Yes

  No

  N/A

• 14. Is it required that only the employee exposed to the hazard, place or remove the safety lock?

  Yes

  No

  N/A

• 15. Is it required that employees check the safety of the lock-out by attempting a startup after making sure no one is exposed?

  Yes

  No

  N/A

• 16. Are employees instructed to always push the E - stop button immediately after checking the safety of the lock-out?

  Yes

  No

  N/A

• 17. Are there a means provided to identify any or all employees who are working on locked-out equipment by their <br> locks or accompanying tags?

  Yes

  No

  N/A

• 18. Are a sufficient number of accident preventive signs or tags and safety padlocks provided for any reasonably <br> foreseeable repair emergency?

  Yes

  No

  N/A

• 19. When machine operations, configuration or size requires the operator to leave his or her control station to install <br> tools or perform other operations, and that part of the machine could move if accidentally activated. Is such <br> element required to be separately locked or blocked out?

  Yes

  No

  N/A

• 20. In the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job the procedure <br> established and rigidly followed?

  Yes

  No

  N/A

• 21. Are all staff wearing correct PPE?

  Yes

  No

  N/A

Sigantories

• Action Required:

• By Whom:

• Target Date:

• Auditee

  Sign

• Auditor

  Sign