LOTO Periodic Inspection Form

Use this LOTO Periodic Inspection Form to verify that lockout/tagout procedures are followed periodically, ensuring accidental energy release is avoided.

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LOTO Periodic Inspection Form

LOTO Periodic Inspection Checks

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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LOTO Periodic Inspection Form

Use this LOTO Periodic Inspection Form to verify that lockout/tagout procedures are followed periodically, ensuring accidental energy release is avoided.

1. Is the written LOTO procedure for the equipment present at the work location or otherwise readily available?

2. If this is a generic procedure, does it identify all equipment that is covered by the procedure?

3. Were all affected employees identified on the procedure and notified of the isolation of the equipment (and when the isolation was complete)?

4. Was the equipment or system properly shut down?

5. Were all the energy sources turned to the off or safe position?

6. Did personnel attach their own locks and tags to each energy isolation device (or use a hasp or lockbox for group lockout)?

7. Did personnel attach the correct warning tags to each energy isolation device, indicating their name and contact number?

8. Was a warning tag used in place of a lock? (if no, skip the bulleted list below)

9. Did the procedure specifically indicate the use of tagout and all additional elements to achieve full employee protection?

10. Did each authorized employee understand their responsibilities under the energy control procedure being inspected, including all the limitations of tags?

11. Was all hazardous energy properly controlled and verified to a zero energy state?

12. Was all stored energy properly dissipated or controlled?

13. Was an attempt made to restart the equipment or system to ensure the effectiveness of the lockout tagout prior to the start of servicing?

14. Were all the steps in the energy control procedure adequate and appropriate to safely isolate the equipment or system to a zero energy state?

15. Were all lockout and tagout devices removed after servicing?

16. Did the involved personnel understand their responsibilities under the procedure?