Lockout/tagout Procedure Inspection Form (Page 2 of 3) in pdf

Lockout/tagout Procedure Inspection Form Page 2

LOCKOUT/TAGOUT PROCEDURE INSPECTION FORM

YES

N/A

SUBJECT

COMMENTS

II. Authorized Employee Knowledge:

Can demonstrate knowledge about the LOTO

program, purpose and employee responsibilities.

Can demonstrate knowledge about the appropriate

lock and tag devices to use for all hazardous energies

to be controlled.

Can demonstrate knowledge about the placement

location of all energy-isolating devices.

Can demonstrate knowledge about any (or all)

hazards and secondary or residual energy.

Can demonstrate knowledge about the energy-

isolation verification procedures.

Can demonstrate knowledge about the necessary

procedures if the equipment does not have a lockable

energy-isolating device.

Has received the required classroom and hands-on

equipment specific training.

III. LOTO Devices

Appropriate LOTO devices available for each type of

hazardous energy to be controlled.

Appropriate support equipment/devices (grounding

rods, measurement tools, etc) available for each type

of hazardous energy to be controlled.

Adequate number of approved locks/tags available.

Approved locks used only for LOTO and no other purpose.

Are LOTO devices singularly identified & standardized?

Are LOTO devices substantial & capable of

withstanding the environment for time of expected

exposure? Will message on tag remain legible?

Are tagout device attachment strength > 50 lbs?

Lockout/tagout Procedure Inspection Form Page 2