• Authorized Employee Audit

  • Select date

  • Person performing audit

  • Name of associate

  • Department

  • Machine or equipment audit was performed

  • If more than one employee, did all employees have a lock on equipment?

  • Have all associates been trained on lockout/tag out:

  • Is training current?

  • Lockout in use?

  • Photo of LOTO being performed

  • Note any deficiencies and/or comments

  • The LOTO audit was conducted and results discussed with associate.

  • Signature of authorized employee

  • Signature of auditor

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