LOTO Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PROCESS

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

  Yes

  No

  N/A

• There is evidence / examples of recent LOTO

  Yes

  No

  N/A

• LOTO Procedure is well understood by Managers and Supervisors

  Yes

  No

  N/A

• LOTO Procedure is well understood by the crewmembers

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Contractors follow the LOTO procedure for services related to Saxon

  Yes

  No

  N/A

• LOTO always completed with conjunction to Permit to Work

  Yes

  No

  N/A

LOTO DEVICES

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

TRAINING

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Other Observations

• Add media

  Media

Sign-off

• Auditor

  Sign

• Site Manager

  Sign