Novelis Oswego - LOTO Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Critical Questions

• Does a written pre-plan exist?

  Yes

  No

• Pre-plan number & title:

• Is this a group or personal lock out?

  Yes

  No

• Is the lockout log filled out for the group lockout?

  Yes

  No

• One person,one lock and tag?

  Yes

  No

• Are tags legible and clearly identify individual placing tag?

  Yes

  No

If NO is indicated then explain:

Authorized/qualified persons with locks placed on lock box/energy source:

Additional comments: