Lockout/Tagout (LOTO) Checklist
Ensure worker safety & regulatory compliance with our comprehensive Lockout/Tagout (LOTO) Checklist for Manufacturing! Download our free, printable checklist to prevent accidents, streamline procedures, and protect your team. Stay OSHA compliant - get your LOTO checklist today!
This Template was installed 4 times.
Pre-Shift Planning & Hazard Assessment
Initial steps to identify hazards and plan the LOTO procedure.
Date of Assessment
Time of Assessment Start
Brief Description of Task/Job to be Performed
Potential Hazards Identified (Initial Assessment)
Hazards Related to Previous Incidents/Near Misses?
Previous Control Measures (if any) & Their Effectiveness
Risk Level (Based on Initial Assessment)
Name of Person Performing Hazard Assessment
Signature of Person Performing Hazard Assessment
Identify Energy Sources
Listing all potential energy sources that need to be controlled.
What types of energy are present?
Describe any unusual or non-standard energy sources.
Voltage of electrical supply (if applicable)
Pressure of pneumatic/hydraulic systems (if applicable)
Identify the primary energy source requiring isolation.
Additional Notes about Energy Sources (e.g., secondary hazards)
Isolation & Shutdown Procedures
Steps for isolating and shutting down equipment.
Detailed Step-by-Step Shutdown Procedure
Equipment ID Number
Shutdown Sequence (e.g., Normal Stop, Emergency Stop)
Location of Primary Isolation Point
Date of Procedure Review/Update (Last Reviewed)
Time of Shutdown Initiation
Any Unusual Considerations for Shutdown?
Lockout/Tagout Application
Applying locks and tags to energy isolation points.
Lock Type Used (e.g., Keyed, Combination)
Lock ID Number
Tag Type Used
Tag ID Number
Tag Information
Lock/Tag Location (Specific Point of Isolation)
Authorized Personnel Applying LOTO
Authorized Personnel Signature (Lock Application)
Verification of Isolation
Confirming that equipment is completely de-energized and safe to work on.
Voltage Reading (Phase-to-Phase)
Voltage Reading (Phase-to-Neutral)
Current Reading (Amps)
Confirm Zero Energy State?
Describe Verification Steps Taken
Sound Check (Confirm no equipment noise)
Movement Check (Confirm no unintended movement)
Verification Date
Verification Time
Work Performance & Observation
Ensuring work is performed safely and observing for any potential issues.
Describe the work being performed on the equipment.
Number of personnel working on the equipment.
Are there any unusual noises or movements observed?
If yes, describe the unusual noises or movements.
Were any tools or equipment accidentally moved or dropped during the work?
If yes, describe the incident and corrective actions taken.
Is anyone experiencing discomfort or noticing anything concerning?
If yes, describe the discomfort or concern.
Removal of LOTO & Equipment Restart
Process for removing locks and tags and safely restarting equipment.
Date of LOTO Removal
Time of LOTO Removal
Reason for LOTO Removal
If 'Other' selected, please explain reason for removal
Was a visual inspection performed?
Equipment Voltage/Pressure after Verification
Confirmation of Clear Communication with Affected Personnel
Authorized Personnel Signature (Removal)
Name (Printed) of Authorized Personnel
Documentation & Sign-off
Recording the LOTO procedure and confirming completion.
Date of LOTO Procedure
Time of LOTO Implementation
Equipment/Machine ID
Brief Description of Work Performed
LOTO Procedure Followed (Reference)
Additional Notes/Observations
Authorized Lockout Person Signature
Affected Employee Acknowledgement
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