OSHA Lockout Tagout Checklist

• Equipment Serial #

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

LOCKOUT/TAGOUT PROCEDURES

• Are all machinery or equipment capable of movement, required to be de-energized or disengaged and locked-out during cleaning, servicing, adjusting or setting up operations, whenever required?

  Yes

  No

  N/A

• Where the power disconnecting means for equipment does not also disconnect the electrical control circuit.

  Yes

  No

  N/A

• Are the appropriate electrical enclosures identified?

  Yes

  No

  N/A

• Are means provided to assure the control circuit can also be disconnected and locked-out?

  Yes

  No

  N/A

• Is the locking-out of control circuits in lieu of locking-out main power disconnects prohibited?

  Yes

  No

  N/A

• Are all equipment control valve handles provided with a means for locking-out?

  Yes

  No

  N/A

• Does the lockout procedure require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment is locked-out for repairs?

  Yes

  No

  N/A

• Are appropriate employees provided with individually keyed personal safety locks?

  Yes

  No

  N/A

• Are employees required to keep personal control of their key(s) while they have safety locks in use?

  Yes

  No

  N/A

• Is it required that only the employee exposed to the hazard, place or remove the safety lock?

  Yes

  No

  N/A

• Is it required that employees check the safety of the lock-out by attempting a startup after making sure no one is exposed?

  Yes

  No

  N/A

• Are employees instructed to always push the control circuit stop button immediately after checking the safety of the lock-out?

  Yes

  No

  N/A

• Are there a means provided to identify any or all employees who are working on locked-out equipment by their locks or accompanying tags?

  Yes

  No

  N/A

• Are a sufficient number of accident preventive signs or tags and safety padlocks provided for any reasonably foreseeable repair emergency?

  Yes

  No

  N/A

• When machine operations, configuration or size requires the operator to leave his or her control station to install tools or perform other operations, and that part of the machine could move if accidentally activated, is such element required to be separately locked or blocked out?

  Yes

  No

  N/A

• In the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job the procedure established and rigidly followed?

  Yes

  No

  N/A

Recommendation

• Write your recommedations here

Completion

• Full Name and Signature of the Inspector

  Sign