• Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Instructions
    1. Answer "Yes", "No", "N/A" for the questions below
    2. Add any photos and notes by clicking on the paperclip icon
    3. To create a corrective action click on the paperclip icon then "Action", provide a description, assign to a member, set priority and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link


  • The Lock Out - Tag Out process is systematically applied when working on energized equipment

  • There is evidence / examples of recent LOTO

  • LOTO Procedure is well understood by Managers and Supervisors

  • LOTO Procedure is well understood by the crewmembers

  • A list of activities subjected to LOTO is visibly posted, the personnel are aware and understand the list

  • All LOTO certificates are formally authorized by the Person In Charge

  • Contractors follow the LOTO procedure for services related to Saxon

  • LOTO always completed with conjunction to Permit to Work


  • LOTO equipment (board) is readily available at all times? General conditions (how many, where, etc)

  • Tags are waterproof to prevent tag from deteriorating or becoming illegible due to wet conditions and weather

  • Tags include legend such as Do Not Start, Do Not Open, Do Not Close, Do Not Energize, Do Not Operate

  • All isolation points are able to be isolated by positive means of locking


  • Personnel know the purpose and the use of the LOTO procedure

  • Energy isolation incidents / lessons learned are commonly distributed to the rigs

  • All personnel are familiar with the PTW process and LOTO supplemental checklists

  • Personnel recognize all type of energy sources requiring isolation through LOTO

Other Observations

  • Additional comments

  • Add relevant photos


  • Auditor

  • Site Manager

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.