Title Page
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Site conducted
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Conducted on
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Prepared by
Operational Lockout & Secured Work Zone
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Who are you auditing today?
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What is the employee position?
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Which machine are you auditing?
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What are you auditing?
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Does the worker stop the equipment using the equipment’s normal operating controls (stop button) and not activating the emergency stop button?
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Does the worker use his left hand and move to the right of the lockout disconnect device when turning off one or more switches (If applicable)?
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Does the worker put his personal lock(s), a borrowed lock(s) or a designated lock to be used on all sources to be controlled?
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Does the worker use a control hasp(s)?
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Why the procedure was not followed?
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Take a photo
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Does the lockout correspond to the operational lockout or secured work zone instruction sheet posted?
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Take a photo of the placard
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Does the worker perform a start-up verification test? (Not applicable to secured work zone placard)
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Does the worker carry out the task safely?
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Before reenergizing equipment: the employee conducts tests and visual inspections, as necessary, to verify that all tools and employees are absent from work area?
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The employee removes personal lock, designated lock or borrow lock or replaces secure work zone key?
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The employee reenergizes equipment?
