Cory Edwards

Machine Assessment (LOTO)

Basic template to quickly annotate hazards during machine assessment

Use this Template

Print as PDF

Use this Template

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Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Assessment

Select energy sources identified.
- Electrical
- Mechanical
- Hydraulic
- Pneumatic
- Chemical
- Thermal
- Other
Type of Current
Magnitude (voltage and amperage)
Describe isolation process and devices.
Add media
Describe mechanical hazard
Describe magnitude of hazard
Describe isolation process and devices.
Add media
Describe magnitude of hazard
Describe isolation process and devices.
Add media
Describe magnitude of hazard
Describe isolation process and devices.
Add media
Describe magnitude of hazard
Describe isolation process and devices.
Add media
Describe magnitude of hazard
Describe isolation process and devices.
Add media
Describe magnitude of hazard
Describe isolation process and devices.
Add media

Cory Edwards

Machine Assessment (LOTO)

Basic template to quickly annotate hazards during machine assessment

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.