Lockout - Tagout (LOTO) Annual Inspection and Training Assessment Checklist . Department: Shop: Location: Equipment: Yes No . 1 A) Has there been a change in job assignments, machines, equipment or processes? B) If so, have employees been re-trained when job assignments, machines, equipment or processes have changed Lockout/Tagout Compliance Guide and Checklist Scope: The OSHA Control of Hazardous Energy (Lockout/Tagout) standard (29 CFR 1910.147) covers the servicing and maintenance of machines and equipment in which the unexpected energization or start up of the machines or equipment or release of stored energy could cause injury to employees
. 2) Verify location of energy isolating devices, magnitude and type of energy. 3) Properly shut down equipment/machine using normal stopping procedures 3. This form is made to print and fill out by hand for those not comfortable filling it out on the computer. Instructions: 1. Download forms from the website and print. Or download the forms, save and then print. 2. Fill in the blanks and tables with appropriate information. See the . LOTO Procedures EXAMPLE 2. for help. 3 *The above Energy Control Lockout/Tagout Checklist is for informational purposes only. This Checklist has been created according to guidelines, standards and requirements set forth by the Occupational Safety and Health Administration, General Environmental Controls CFR 1910.147, The Control of Hazardous Energy (Lockout/Tagout) (www.osha.gov)
Lockout/Tagout (LOTO) Procedure Template. Pub-3000, Chapter 18, Work Process N addresses LOTO Procedures. A LOTO procedure is a formal document detailing all the steps required to establish the lockout. It is specific both to the equipment or system and to the scope of work. A LOTO procedure is required for all complex LOTOs Following OSHA lock-out tag-out procedure standards by using a procedures template and safety checklist will help ensure that all dangerous machinery and equipment are properly shut off, locked out, and tagged before performing maintenance checks. OSHA estimates that complying with LOTO standards helps prevent 120 fatalities and 50,000 injuries each year Lancaster Safety Consulting, Inc. 100 Bradford Road, Suite 100 Wexford, PA 15090 Phone: (888) 403-6026 Fax: (724) 776-1007 www.LancasterSafety.com Page 2 of E. Removal of an Authorized Employee's Lockout/Tagout by the Employer F. Shift or Personnel Changes G. Procedures for Outside Personnel/Contractors H. Training and Communication I. Periodic Inspection IV. Attachments A. List of Equipment Requiring a LOTO Procedure Form B. Equipment Specific LOTO Procedure Form
LOCKOUT TAGOUT PROCEDURE LOTO Procedure Development Form_2 Revision Date: 2-Nov-18 page 1 of 3 Instructions: • Complete each section of the form. Where a step or section does not apply, write n/a. • Return completed forms to the department supervisor or manager for review and approval Lockout - Tagout Worker Competency checklist . Please use this as a guide for building your own Safe Work Practices. (2018) www.AgSafeBC.ca | 1 . Instruction to supervisor: After completion of an in-class Lockout - Tagout session, demonstrate to each worker where to find locks, tags and any equipment specific procedures 3 Comprehensive LOTO Checklists Based on OSHA Standards. Safesite takes the guesswork out of writing and preparing checklists that adhere to OHSA, CalOSHA, MSHA, etc. standards. Our mobile inspection checklists are available for free on our in-app template library. Here are a few standard checklists for LOTO procedures, inspections, and energy.
GS-146 Lockout - Tagout (LOTO) Annual Inspection and Training Assessment Checklist . Department: Shop: Location: Equipment: Yes No 1 A) Has there been a change in job assignments, machines, equipment or processes? B) If so, have employees been re-trained when job assignments, machines, equipment or processes have changed LOTO Equipment Checklist. Download this Lockout/Tagout Equipment Checklist to get started: View a typical equipment list for your facility. Record the number of procedures you'll need. Create your own equipment checklist
Lock out tag out (also known as lock and tag or LOTO) is a procedure which companies and people working in the industries use to ensure dangerous machines and equipment are properly shut off, isolated, and not able to start up again prior to the completion of work - which can be maintenance, research or any other form of work Lockout/Tagout (LOTO) Compliance Guide Prepared for _____ By _____ Date _____ Scope The OSHA Control of Hazardous Energy (Lockout/Tagout) standard (29 CFR 1910.147) covers the servicing and maintenance of machines and equipment in which the unexpected energization, start up of the machines or equipment, or release of stored energy could cause.
Observation checklist | Lockout tagout Subject: Document lockout/tagout employee safety observation Keywords: electricity electrical safety checklist documentation supervisor guide SSG observation checklist LOTO lockout/tagout supervisors guide Last modified by: Mary Ann Potter Company. The Tata Power Company Ltd Lock Out Tag Out (LOTO) Document Title Procedure Document Ref No: TPSMS/CSP/LOTO/001 Rev 01 Date of Issue: 01/01/2016 Contents Section Description Page No. 1.0 OBJECTIVE 3 2.0 SCOPE 3 3.0 EXPECTED RESULTS 3 4.0 ACCOUNTABILITY & RESPONSIBILTIY 3 5.0 GLOSSARY/ DEFINITIONS 3 6.0 PROCEDURE 6 7.0 RECORDS 1
This LOTO program audit checklist is easier to use and manage than word, PDF and excel docs: Access, complete, update and sign off on your LOTO program audit checklist from any mobile, tablet or computer. Customise the layout and contents of the audit checklist to suit your company, projects and operations Lockout/tagout inspection form. Note to employers: Use this form to document an inspection of a written lockout or tagout procedure. Department: Equipment type and serial number APPLYING LOCKOUT/TAGOUT DEVICE AUDIT ITEMS Appropriate locks, tags, and lockout devices were available and utilized. Yes : No CONTROLLING STORED ENERGY AUDIT ITEMS All potential residual hazardous energy was relieved, disconnected, or restrained (e.g., trapped pressure relieved, pipe flanges blanked, elevated equipment blocked or supported). Ye Lockout and Tagout Policy for [enter COMPANY NAME] Purpose: This procedure establishes the minimum requirements for the lockout of energy isolating devices whenever maintenance or servicing is done on machines or equipment. It shall be used to ensure that the machine or equipment i
5. Apply lockout/tagout devices (lockout all energy isolating devices/points, tag placed on lockout device contains required information, group lockout is used-if more than one employee is involved) 6. Verify that machine/equipment is completely de -energized (challenge locks, try to star . 5 The OSHA Lockout/Tagout (LOTO) Standard The OSHA LOTO Standard The Control of Hazardous Energy CFR 29, Part 1910.147 Lockout / tag out - Intends to prevent the unexpected energization or start-up o
This lockout tagout (LOTO) inspection form is free and customisable for any of your periodic inspections. Lockout tagouts are a key area for site and worker safety, and companies create strong and reliable LOTO programs for ensuring their teams and sites remain safe Lockout/Tagout (LOTO) Checklist Steps to Apply LOTO Step Action 1. Prepare for shutdown. Notify . affected workers. Review procedures. Identify all energy sources. Ensure all isolating devices will accept lockout/tagout devices. Gather necessary tools, equipment. Identify any supporting equipment or systems that must also be shutdown. 2 LOTO PERFORMANCE Were approved locks and tags used? Were all affected personnel notified of the equipment to be isolated and the expected duration? Was the equipment shutdown in accordance with approved operating instructions? Employee(s) Performing LOTO: Auditor (Print Name): Date: LOTO PREPARATION LOCK OUT / TAG OUT AUDIT FORM ScanESC™ is user-friendly software that simplifies and improves your LOTO program. Innovative lockout/tagout software helps reduce risk and improve productivity
Chapter 10 - Form 1: Lockout / Tagout Checklist H&SM, Chapter 10, Control of Hazardous Energy and Lockout/Tagout, July 2019 Page 2 of 2 Verify employees instructed to lock equipment and machinery out at the main power disconnects. _____ Verify that the lockout/tagout procedure requires that stored (potential) energy be released o Checklist lockout-tagout_checklist.doc Dec 2010 Page 1 Purpose This lockout and tagout (LOTO) procedure provides the minimum requirements for the LOTO of energy-isolating devices whenever maintenance or servicing is done on machines or equipment. LOTO shall be used to ensure that the machine or equipment is stopped and isolated from all. This checklist is for authorized employees only. **Edit this template according to your company's procedure.** Features. Templates. Blog. Pricing. Login Get Started Free. Back to Library. Lockout/Tagout/Try (LOTO) Procedure. Contributor: Safesite Jurisdiction: OSHA. general industry. This checklist is for authorized employees only. **Edit this. (Lockout/Tagout) Lockout/Tagout Checklist Energy Control Program ☛ Your company has an energy control program that prohibits service or maintenance on powered equipment unless energy has been drained and lockout/tagout procedures performed. ☛ All locations requiring lockout/tagout are identified
Appendix A: Lockout and Tagout Procedure Self-Assessment Checklist Functional supervisors ensure that authorized employees adhere to the requirements of the Lockout and Tagout Program. Use the checklist below, and then complete the Lockout and Tagout Inspection Form in this Appendix. Authorized Employee Knowledg Example elements of a lockout/tagout (LOTO) program are described in the OSHA standard for the control of hazardous energy (29 CFR 1910.147), along with these additional references. Case Studies. Presents a series of case studies for review, followed by related questions. Each of the case studies is. covered by the Control of Hazardous Energy (Lockout/Tagout) Standard. This may be accomplished by using the Equipment Lockout Work Plan form in Appendix D. These written, machine or equipment specific procedures must identify the information that the authorized employee(s) must know to control hazardous energy (steam, water, natural gas
A good Lockout/Tagout Procedure, at a minimum, should contain the following elements: 1. All maintenance personnel shall be provided with a good lock. The lock shall have the individual workers' name and other identification on it. Each worker shall have the only key to the lock Appendix C: Emergency Safety Lockout/Tagout (LO/TO) Device Removal Checklist This form must be fully complete by the Supervisor authorizing the removal of the Lockout or Tagout device anytime such a device must be removed by any individual other than the person who applied it A Lockout/Tagout procedure or method should include the following six steps: 1. Preparation 2. Shutdown 3. Isolation 4. Lockout/Tagout 5. Stored energy check 6. Isolation verification. Let's have a look at the each of these steps of LOTO safety more firmly in the sections below
Emedco LOCKOUT / TAGOUT Checklist. This Checklist constitutes a basic guide for Lockout/Tagout procedures according to guidelines, standards, and requirements issued by the Occupational Safety and Health Administration CFR 1910.147 and does not include all comprehensive requirements for specific industries or facilities Lockout/Tagout Program ANNUAL AUDIT CHECKLIST In accordance with OSHA (U.S. Occupational Safety and Health Administration) standard 1910.147, companies must perform an annual inspection of their established energy control procedures and authorized employees. This annual audit is done to confirm all lockout/tagout procedures are adequate
The specific section of the Lockout/Tagout (LOTO) standard I am referring to in this post is paragraph 1910.147 (c) (6) (i), which requires employers to conduct a periodic inspection of the energy control procedure at least annually to ensure that the procedure and the requirements of this standard are being followed A warehouse checklist is used by safety officers and warehouse workers to identify safety hazards and come up with preventive measures to avoid accidents and injury. Maintaining and using multiple warehouse checklists can be burdensome and unproductive. iAuditor is a powerful inspection app that allows you to schedule and conduct your warehouse. AFMAN 91-203 Air Force Occupational Safety, Fire and Health Standards Checklist . Revision Date: 08 January 2020 Page | i . Introduction: The checklists contained herein is created by AFSEC/SEGS to assist Air Force personnel in meeting th Importance of Lockout/Tagout LOTO is a process to control energy hazards for preventing accidental start-up or release of stored energy during set-up, maintenance and servicing of equipment. LOTO prevents an estimated 120 fatalities and 50,000 injuries each year. Form 3 Affected Employee Training Certification Form 4 Other Employee Training Certification Form 5 Annual Power Lockout/Tagout Certified Inspection Worksheet Form 6 Documentation of Information Given to Contractors Pertaining to Lockout/Tagout Procedures HAZARDOUS ENERGY CONTROL (LOCKOUT/TAGOUT) PROGRAM
Sign Section 2 of the Permit (sign on/sign off form) indicating that the group lockout is complete and the equipment is ready for work. 10 Qualified Electrical Worker(s) GROUP LOCKOUT CHECKLIST 2 Authorized Worker, Lead Authorized Worker, Equipment Custodian, or other competent person as assigned by supervision 9 Lead Authorized Worke Lock out procedure annual review form. - Annual Lockout - Tagout Administrative review of detailed writen procedures of lockouts for equipment. Lockout Tagout Training Form - Ensures that training has been received on the Mandatory Lockout - Tagout Program. Provides checklist of items to be trained on A lockout/tagout program is designed to address risks posed by hazardous energies. Before service/maintenance activities begin, the machine or equipment shall be isolated from the energy source and rendered inoperative. At a minimum, an employer's lockout/tagout program must include: A
View Lockout-Tagout-Inspection-Checklist.pdf from BIS 2018 at University of Ottawa. Lockout/Tagout Periodic Inspection Digital Safety Evaluation Form Series - LOTO-01 Page 1 o Lockout/Tagout (LOTO) Permits are a key element of LOTO programs helping to ensure equipment maintenance operations are completed safely. Implementation of a safe work permit system can help reduce the risk of serious injuries or death caused by unexpected operational accidents.. The app is built by EHS experts and allows clients to customize the app with your company specific fields and. Condition. Requirements for employee protection. 1. If the machinery or equipment must be capable of movement during cleaning, servicing, and adjusting operations in order to perform the specific task. The employer shall minimize the hazard by providing and requiring the use of extension tools (eg., extended swabs, brushes, scrapers) or other. This inspection shall be conducted utilizing the Lockout/Tagout Periodic Inspection - Checklist and Certification. This inspection shall be utilized to correct any deviations or inadequacies identified and shall include a review between the inspector and each authorized and affected employee
LOTO is required because other-than minor cleaning must be performed. •e.g., prying, pulling, scrapping, and/or chipping) or even machine component (e.g., die) disassembly •This now requires LOTO Examples Of Effective Alternative Protection (Minor Servicing Exception) Lockout/Tagout & Employee Protection (CPL:Pg. 2-16 Lockout/Tagout Job Surveillance Guidance Card/Checklist Rev 1 - 01/01/2014 1 This guidance card/checklist is intended to be used as a tool when observing a LOTO in process. Side 1 is a checklist of training requirements and specific LOTO steps. Complete Side 1 for the observed LOTO activities *This checklist is for informational purposes only. It was created according to guidelines, standards and requirements set forth by the Occupational Safety and Health Administration, General Environmental Controls CFR 1910.147, The Control of Hazardous Energy (Lockout/Tagout) (www.osha.gov). This checklist was develope GS-146 Lockout - Tagout (LOTO) Annual Inspection and Training Assessment Checklist . Department: Shop: Location: Equipment (Please check all equipment procedures that were reviewed on Page 2) Yes No 1 A) Has there been a change in job assignments, machines, equipment or processes? B) If so, have employees been re-trained when job assignments
APPENDIX F: LOTO PERIODIC INSPECTION CHECKLIST The immediate Supervisor and Program Coordinator shall be notified immediately if any of the following criteria are not met during an inspection. The inspecting employee shall report any deviations or inadequacies, and take appropriate action to ensure the safety of all affected individuals . A LOTO procedure is a formal document detailing all the steps required to establish the lockout. It is specific both to the equipment or system and to the scope of work. A LOTO procedure is required for all complex LOTOs. View the complete process HERE Forms. Appendix B - Equipment Specific LOTO Procedure Development Form - Blank. Appendix C - Lock Removal Form. Appendix D - Contractor Notification Form. Appendix E - LOTO and Electrical Work Evaluation Checklist. Lockout/Tagout Summary: Failure to use lockout/tagout procedures put hundreds of employees at risk of injury to hazardous energy each year. But there are many effective precautions you can take. Use this lockout/tagout checklist to ensure that your lockout/tagout procedures are up-to-date. Click on this button to download/view the document
Our Basic Lockout/Tagout Inspection Form is a simple form that provides the main lockout steps and allows the user to add their own steps into the process or use as is. Our Enhanced Lockout Inspection Form is a multipage form that's great for taking a deep dive into the inspection process and allows for documenting corrective actions 7.0 Group LOTO E Annual LO/TO Self-Audit Form 19 F Extended Shift Form 21 G Routine Daily Lockout/Tag-out Activity 22 H Training Log 23 I Lock Removal Form 25 Revisions 26 . Department: Environmental Health and Safety 3 Document: Lock-out Tag-out Program (Zero Energy State) 8/8/17. . Workers can be electrocuted, suffer severe crushing injuries, and lose fingers, hands, and arms because machinery is inadvertentl
Supervisors are responsible for maintaining the following records in order to meet the requirements of the Lockout / Tagout Plan: LOTO Equipment-Specific Procedures Form; LOTO Inspection Checklist; Machine and Machine Shop Safety. Please review the Machine and Machine Shop Safety Guide for more information on how to complete this form When more than one employee is involved in a lockout or tagout process, a special energy isolation plan is needed. Read more on Better MRO: https://bit.ly/2W..
Equipment specific lockout/tagout (LOTO) procedures for the control of potentially hazardous energy must be developed, documented and utilized whenever machinery could unexpectedly activate or if the unexpected release of an energy source could cause injury to employees performing any servicing or maintenance .8, Chapter 12 for samples Figure 12-1, NAVMC 11402, LOTO Evaluation Figure 12-2, NAVMC 11403, LOTO Checklist Figure 12-3, NAVMC 11404, LOTO Log.
EHS-00008 R8 Lockout Tagout (LOTO) Program EHS-00008-F1 R5 Lockout-Tagout Procedure EHS-00008-F2 R5 Lockout Tagout Periodic Inspection Form EHS-00008-F3 R5 Authorization for Removal of Lockout-Tagout Devices EHS-00009 EHS-00030-F1 R4 Equipment Decommissioning and Removal Sign-Off Checklist EHS-00031 R21 Toxic Gas Monitoring. LOTO Procedural Checklist Audit Department: EHS Level: Form Document Code: EHS-F-LOTOPCA Initialized On: Unknown Revision: 03 Revision Date: 12-05-2018 Initialized By: Unknown Revised By: Cody Collett Page Number: Page 1 of 1 *This document is intended solely for the use of Polk Mechanical Company employees Lockout/Tagout C. Lockout/Tagout Devices Lockout/tagout (LOTO) equipment consists of tags, locks, hasps, chains, and other hardware used to prevent the operation of equipment being serviced or maintained. Lockout devices must be used whenever possible, to ensure a positive means of energy control, by holding equipment in a SAFE or OFF position Each worker MUST complete this checklist when working on the energy source. State the source (e.g. pressure/pneumatic, hydraulic, electrical) Print name, sign and date confirming work complete or LOTO transfer completed with new form. STOP if not clear how to do the work LOTO procedures are the foundation of LOTO training. This training must be documented and is required to Authorize and Qualify personnel to perform Shut Downs. Refer to the UVA Facilities Management - Lockout/Tagout Program , Appendix C.1 for the LOTO Equipment Specific Project Summary Form, all of the LOTO steps to follow have been included.