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Audit

General Information

Nature of work

Take a photo of the equipment/machinery
Hazardous energy sources

Enter other energy source

Purpose of Lockout Tagout procedure

Employees involved in the LOTO

Area Inspection

Have nonessential items (e.g., tools, spare parts) been removed from the work area?

Are all of the machine or equipment components operationally intact?

Are all employees safely positioned or have cleared the area?

Have all affected employees been notified that the lockout or tagout devices have been removed before the equipment started?

Have lockout or tagout devices been removed from the energy-isolating device by the employee who applied them?

Employees

Are the employees knowledgeable about the Lockout/Tagout Procedures and their responsibilities?

Are affected employees notified when the procedure is being used?

Have affected employees been trained to recognize when the procedure is being used and instructed not to remove lockout/tagout devices or start de-energized equipment?

Lockout/Tagout Devices

Are LOTO devices manufactured from durable materials to stand the industrial environment of their use?

Are they substantial enough to prevent removal without the use of excessive force?

Do they clearly identify the employee who installed the device?

Applying LOTO devices

Have all sources of power been checked before shutting down the equipment?

Are all effective employees notified that you are ready to start a LOTO procedure?

Is the equipment stopped by following its normal shutdown procedure?

Is the equipment isolated by turning off the energy at the main power source?

Are lock and appropriate lockout device (tags) applied to each energy isolating device?

REFERENCE: Proper lockout and tagout device attached to the power source of the isolated device.
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

lockout_tagout_device2.jpg

Has the power been shut off and verified?

Removing LOTO devices

Are all tools removed and machine guards replaced?

Are all employees cleared off the machine?

Are the LOTO devices removed by the person who applied them?

Are all affected employees notified that LOTO devices have been removed?

Is energy restored properly?

Completion

Recommendations

Full name and Signature of the Inspector

Lockout Tagout Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 367

Use this checklist before servicing industrial equipment. Record the nature of work, hazardous energy sources and the employees involved in the procedure. Do a site walkthrough to ensure that the area is cleared from unnecessary tools and check if employees are trained and notified about the procedure. Next check the quality and efficiency of LOTO devices being used. Evaluate if the step-by-step procedure was followed when applying and removing LOTO devices. Lastly, rate the overall LOTO process and provide recommendations.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Audit

General Information

Nature of work

Take a photo of the equipment/machinery
Hazardous energy sources

Enter other energy source

Purpose of Lockout Tagout procedure

Employees involved in the LOTO

Area Inspection

Have nonessential items (e.g., tools, spare parts) been removed from the work area?

Are all of the machine or equipment components operationally intact?

Are all employees safely positioned or have cleared the area?

Have all affected employees been notified that the lockout or tagout devices have been removed before the equipment started?

Have lockout or tagout devices been removed from the energy-isolating device by the employee who applied them?

Employees

Are the employees knowledgeable about the Lockout/Tagout Procedures and their responsibilities?

Are affected employees notified when the procedure is being used?

Have affected employees been trained to recognize when the procedure is being used and instructed not to remove lockout/tagout devices or start de-energized equipment?

Lockout/Tagout Devices

Are LOTO devices manufactured from durable materials to stand the industrial environment of their use?

Are they substantial enough to prevent removal without the use of excessive force?

Do they clearly identify the employee who installed the device?

Applying LOTO devices

Have all sources of power been checked before shutting down the equipment?

Are all effective employees notified that you are ready to start a LOTO procedure?

Is the equipment stopped by following its normal shutdown procedure?

Is the equipment isolated by turning off the energy at the main power source?

Are lock and appropriate lockout device (tags) applied to each energy isolating device?

REFERENCE: Proper lockout and tagout device attached to the power source of the isolated device.
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

lockout_tagout_device2.jpg

Has the power been shut off and verified?

Removing LOTO devices

Are all tools removed and machine guards replaced?

Are all employees cleared off the machine?

Are the LOTO devices removed by the person who applied them?

Are all affected employees notified that LOTO devices have been removed?

Is energy restored properly?

Completion

Recommendations

Full name and Signature of the Inspector