• Machine/Equipment

  • Authorized Personnel

  • Affected Personnel

Observation of locking and tagging out the equipment

  • Did the authorized team member inform all affected team members?

  • Did the authorized team member turn off the machine or equipment?

  • Did the authorized team member locate and isolate all energy control devices? (eg. switches, breakers, air valves, etc.)

  • Did the authorized team member apply locking or tagging devices to the appropriate energy control devices?

  • Did the authorized team member remove, release, or secure stored energy? (eg. capacitors, air pressure, etc.)

  • Did the authorized team member consider secondary energy sources during process?

  • Did the authorized team member try to run the machine or equipment before work or maintenance started on machine or equipment?

  • Did the authorized team member return all controls to the off or safe position before work or maintenance started on machine or equipment?

Restoring energy to machine or equipment

  • Before starting machine or equipment, did the authorize team member clear all affected team members from the machine, equipment, or area?

  • Before starting machine or equipment, did the authorize team member clear all tools and materials from area?

  • Did the authorized team member ensure all machine guards were in place before start up?

  • Did the authorized team member performing the lockout/tagout remove his or her lockout/tagout devices?

  • Has power been restored by the authorized team member?

  • Did the authorized team member turn on the machine or equipment and cycle through an operation to ensure start up was completed?

  • Did the authorized team member notify all affected personnel the process is complete?

General Observations

  • Did EACH authorized team member working on the machine or equipment affix and remove their individually identified lock?

  • Did the lock and/or tag identify the individual?

  • When multiple team members lockout/tagout the same machine or equipment, was a supervisor assigned to monitor the process.

  • Auditor's Name and Signature

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