Information
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Name of Equipment or Area Being Audited
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Picture of Equipment or Area Being Audited
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Energy Isolation (LOTO) Audit
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Date and Time of Audit
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Auditor's Signature
- Energy Isolation Point
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Type of Energy Present In This Location
- Electricity
- Gas(Propane, Natural Gas...)
- Gravity
- Hydraulic
- Pneumatic
- Steam
- Thermal (Extreme Hot/Cold)
- Water/Chemical or Coolant
- Other
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Picture of Equipment Being Isolated
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Picture of The Actual Lock-out Point(i.e. Circuit breaker, Valve, etc)
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Where is it (specific area, building column numbers, etc)?
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What Specific Equipment/Area Does This Affect (Isolate)?
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Describe Any Special Conditions or Required Shutdown Procedures That Exist
