• Document No.

  • Conducted By:

  • Conducted on

  • Personnel

  • Equipment/Area

  • LOTO Activity Type

  • Shift

Preparing for shutdown audit items:

  • The employee(s) has been trained in the general lockout/tagout procedure?

  • Date of training:

  • Does each employee have personal locks and tags available for use?

  • Record Lock Numbers.

  • Are all employee locks identified with employees name, department and picture? (Inspect all locks if employee has more than one lock).

  • Are the hazardous energy control procedures available in the work area?

  • The employee was able to identify all energy sources for the equipment involved?

  • The employee notified all affected employees in the area?

  • Is the LOTO procedure being followed appropriately?

Shutting down the equipment audit items:

  • The employee shut down all equipment involved using normal shutdown procedures (e.g., putting a switch in the "off" position or pressing a button)?

Isolating the equipment audit items: NOT APPLICABLE FOR ROUTINE LOCKOUT!

  • The equipment was isolated from every energy source feeding into it (e.g., close valves, throw main disconnects, throw circuit breakers)?

Applying lockout/tagout devices audit items:

  • Appropriate locks, tags, and lockout devices were available and utilized?

  • All employees involved were locked out using their own personal locks and tags?

Controlling stored energy audit items: NOT APPLICABLE FOR ROUTINE LOCKOUT!

  • All potential residual hazardous energy was relieved, disconnected, or restrained (e.g., mechanical, hydraulic, air, etc.)?

Verification of isolation audit items:

  • The equipment was tested to ensure the right system(s) we're locked out and to ensure that the equipment could not be operated?

Removing locks and tags audit items:

  • All tools and equipment has been removed from the area?

  • All personal lockout/tagout devices were removed by the employee who applied them?

  • Affected employees have been notified that locks and tags have been removed and the equipment is ready for use?

  • Is the employee aware of the procedure for removing a lock when the authorized employee cannot be found and the lock has to be removed?


  • List any problems identified during the audit:

  • Photos

Resolution to problems identified:

  • List corrective actions taken to rectify the problems listed above:


  • Employee signature:

  • Auditor signature:

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