Title Page

  • Location

  • Conducted on

  • Prepared by

  • Department

  • Machine

  • Is LOTO posted on machine?

  • Where is LOTO posted?

  • Is LOTO current?

  • Does LOTO have signatures?

  • Are LOTO devices available for the equipment?

LOTO Posting

  • How many LOTO Points are listed?

  • Types of Energy sources

  • Are photos included of LOTO points?

  • Are LOTO points marked at the source

  • Are clear instructions posted how to perform LOTO?

Team Members

  • How many Team Members are assigned to the machine?

  • Have the Team Members been trained in LOTO?

  • When was Team Member last trained?

  • What classification of training have the Team Members been trained for?

  • Have Team Members demonstrate knowledge of LOTO, hands on performance

Verification

  • Have Team Member training been verified by documented training records?

  • Comments:

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