Lockout/tagout Procedure Inspection Form Page 3

LOCKOUT/TAGOUT PROCEDURE INSPECTION FORM

YES

N/A

SUBJECT

COMMENTS

Are tags attachment of non-reusable type?

Do tags indicate the identity of employee applying?

10.

Are tags labeled properly (do not operate, start, etc)

IV. LOTO Practices:

Written energy control procedure(s) followed.

Locks were placed and labeled using personal locks.

Tags were placed and labeled.

All stored energy was released and prevented from

reaccumulation.

Control of all hazardous energies was verified by all

authorized users.

Procedures for release from LOTO were followed.

Each Authorized Employee involved in the procedure

was able to describe their LOTO responsibilities.

Are affected persons notified? By whom?

Are affected persons trained?

V. Effectiveness:

Discrepancies found in procedure(s):

Discrepancies found in knowledge:

Discrepancies found in practices:

Other Notes:

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Parent category: Business