Lockout - Tagout Audit

Facility _______________  Area ______________

Auditor _______________    Date __________

Area Satisfactory Action Required Action completed
Employee Knowledge
Date of training      
Purpose of LOTO      
Devices Used      
Procedure Location      
Energy Control Methods      
Programs Administration
Training Certificates      
Annual review of program      
Equipment Procedures      
Annual proficiency review      
List of Locks Issued      
Safeguards
Engineering Safeguards      
Administrative Safeguards      
Training Safeguards      
Area Inspection
Standardized Locks & Tags      
Locks issued to individuals      
Notification procedures      
LOTO procedure used      
Sufficient devices available      
Operational Questions
  Is 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?
Where the power disconnecting means for equipment does not also disconnect the electrical control circuit:
 
Are the appropriate electrical enclosures identified?
 
Is means provided to assure the control circuit can also be disconnected and locked-out?
  Is the locking-out of control circuits in lieu of locking-out main power disconnects prohibited?
  Are all equipment control valve handles provided with a means for locking-out?
  Does the lock-out procedure require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment is locked-out for repairs?
  Are appropriate employees provided with individually keyed personal safety locks?
  Are employees required to keep personal control of their key(s) while they have safety locks in use?
  Is it required that only the employee exposed to the hazard, place or remove the safety lock?
  Is it required that employees check the safety of the lock-out by attempting a startup after making sure no one is exposed?
  Are employees instructed to always push the control circuit stop button immediately after checking the safety of the lock-out?
  Is there a means provided to identify any or all employees who are working on locked-out equipment by their locks or accompanying tags?
  Are a sufficient number of accident preventive signs or tags and safety padlocks provided for any reasonably foreseeable repair emergency?
  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?
  In the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job procedure established and rigidly followed?
Notes