LOTO Monthly Audit - AMTB

• Document No.

• Conducted By:

• Conducted on

  Date

• Personnel

• Equipment/Area

  Select F1151 F1152 A1151 A1152 Electrical Room Compressors BUSS Duct

  • F1151
  • F1152
  • A1151
  • A1152
  • Electrical Room
  • Compressors
  • BUSS Duct

• LOTO Activity Type

  Zero Energy

  Routine Entry

• Shift

  1st Shift

  2nd Shift

  3rd Shift

Preparing for shutdown audit items:

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

  Yes

  No

  N/A

• Date of training:

  Date

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

  Yes

  No

  N/A

• Record Lock Numbers.

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• The employee notified all affected employees in the area?

  Yes

  No

  N/A

• Is the LOTO procedure being followed appropriately?

  Yes

  No

  N/A

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)?

  Yes

  No

  N/A

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)?

  Yes

  No

  N/A

Applying lockout/tagout devices audit items:

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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.)?

  Safe

  At Risk

  N/A

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?

  Yes

  No

  N/A

Removing locks and tags audit items:

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A

• 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?

  Yes

  No

  N/A

Problems:

• List any problems identified during the audit:

• Photos

  Media

Resolution to problems identified:

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

Signatures:

• Employee signature:

  Sign

• Auditor signature:

  Sign