Mining Lockout Tagout (LOTO) Checklist
Ensure worker safety & prevent accidents with our comprehensive Mining Lockout Tagout (LOTO) Checklist. Stay compliant, minimize risk, and maintain operational efficiency with this essential tool for your mining site. Download now and prioritize safety!
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Pre-LOTO Planning & Preparation
Ensuring thorough planning and necessary preparations are completed before initiating lockout/tagout procedures.
Scheduled LOTO Date
Reason for LOTO
Affected Area/Zone
Equipment ID
Potential Hazards Identified
LOTO Supervisor
LOTO Supervisor Signature
Equipment Identification & Isolation
Accurate identification of equipment to be locked out and verification of isolation points.
Equipment Name/Description
Equipment ID/Asset Tag
Serial Number (if applicable)
Energy Source Type(s)
Specific Isolation Points (e.g., valve numbers, breaker IDs)
Isolation Point Location (GPS Coordinates or description)
Equipment Diagram/Drawing (if available)
Energy Source Isolation
Detailed steps for isolating all relevant energy sources (electrical, mechanical, hydraulic, pneumatic, chemical, thermal).
Energy Source Type
Detailed Isolation Procedure Description
Circuit Breaker Number (if applicable)
Date of Last Isolation Check
Time of Isolation
Isolation Point Verified?
Photo of Isolation Point (optional)
Lock and Tag Application
Proper application of locks and tags with unique identifiers for each authorized employee.
Lock Type Used
Tag Type Used
Lock Identifier (Unique Code)
Tag Identifier (Unique Code)
Locking Employee Signature
Tag Number (If Applicable)
Lock Placement Verified?
Notes/Comments (if applicable)
Verification of Isolation
Testing and verifying that equipment is completely de-energized and cannot be inadvertently started.
Voltage Reading (Volts)
Pressure Reading (PSI)
Mechanical Brake Status
Hydraulic Cylinder Status
Additional Verification Notes
Verifier Signature
Communication & Authorization
Confirming communication and authorization among personnel involved in the LOTO process.
Authorized Personnel Communication Method
Communication Log - Brief Summary
Employee ID of Authorizing Personnel
Date of Authorization
Time of Authorization
Signature of Authorizing Personnel
LOTO Removal & Re-Energization
Controlled and authorized removal of locks and tags, followed by equipment re-energization and testing.
Re-Energization Date
Re-Energization Time
Re-Energization Authorized By (Role)
Re-Energization Authorization Signature
Voltage/Pressure Test Result (Post Re-Energization)
Test Result Pass/Fail
If Fail, describe issue
Documentation & Record Keeping
Maintaining accurate records of LOTO procedures, personnel involved, and equipment serviced.
LOTO Procedure Date
Equipment Identifier
Authorized Personnel Initials
Lock/Tag Number
Notes/Observations
Lockout Personnel Signature
LOTO Status
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