Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Authorized Employee Audit
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Select date
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Person performing audit
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Name of associate
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Department
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Machine or equipment audit was performed
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If more than one employee, did all employees have a lock on equipment?
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Have all associates been trained on lockout/tag out:
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Is training current?
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Lockout in use?
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Photo of LOTO being performed
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Note any deficiencies and/or comments
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The LOTO audit was conducted and results discussed with associate.
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Signature of authorized employee
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Signature of auditor
