Information
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Client / Site
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Conducted on
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Prepared by
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Case #
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Equipment
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INV #
Awareness
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LOTO
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Photos of Locks on MV
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# of Feeders inside unit being worked on
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# of Locks used on LBD's
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Photos of Locks on LBD Boxes
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Keys stored in lockbox
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Personnel
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Personnel
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Personnel
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Personnel
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Personnel
Loto Lifted
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Boxes being Lifted
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Time Lifted
Loto Reinstated
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Boxes Reinstated
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Time Reinstated
Full LOTO Removed
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Number of locks removed
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Time of last lock removed
LOTO Transfer
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LOTO Transferred too?
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Number of locks transferred
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Time of transfer
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Personnel
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Personnel
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Personnel
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Personnel
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Personnel