Title Page
-
Document No.
-
Audit Title
-
Conducted on
-
Inspector/supervisor name
-
Employee implementing lockout/tagout
-
Client / Site
-
Location
-
Job completed in accordance with machine specific lockout/ragout procedure?
-
Is the machine specific lockout procedure available at work site?
-
Equipment locked out:
-
List energy sources: (mechanical, electrical, etc...)
-
Type of isolation methods (lock, tag, etc...)
-
Were the switches on the equipment properly and permanently labeled?
-
Was the effectiveness of the lockout verified?
-
Were the employees trained on LOTO within the last 12 months?
-
Does each employee have a personal lock available to use?
