Anonymous

LOTO Assessment

Use this Template

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Use this Template

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Title Page

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Machinery/Equipment Name
Name
Location
Picture of Machinery/Equipment
Number of Lockout Points
#
Energy Type
- Electrical
- Mechanical
- Hydraulic
- Pneumatic
- Chemical
- Thermal
- Other
Method
Lockout Point
Lockout Device

Anonymous

LOTO Assessment

Use this Template

Print as PDF

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