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Loto Checklist

The document outlines a lock out tag out checklist for ensuring hazardous energy sources are properly isolated during maintenance or servicing, with questions to verify employees are knowledgeable about lock out procedures, lock out devices are properly installed and used, and all steps are followed to isolate energy and clear personnel before restoring power. The checklist is to be approved by an inspector and environmental health and safety representative to confirm lock out procedures are properly implemented.

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6K views2 pages

Loto Checklist

The document outlines a lock out tag out checklist for ensuring hazardous energy sources are properly isolated during maintenance or servicing, with questions to verify employees are knowledgeable about lock out procedures, lock out devices are properly installed and used, and all steps are followed to isolate energy and clear personnel before restoring power. The checklist is to be approved by an inspector and environmental health and safety representative to confirm lock out procedures are properly implemented.

Uploaded by

Santosh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Lockout Tag Out Checklist: Provides a comprehensive checklist for ensuring safe lockout and tagout procedures in various energy control scenarios.

LACK OUT TAG OUT CHECK LIST

Nature of work:

Hazardous Energy Sources:


Electrical Mechanical Hydraulic Pneumatic Chemical
Thermal Other (Steam, Stored energy etc)

Purpose of LOTO procedure:

Employees involved in the LOTO:

AREA INSPECTION
Are all of the machine or equipment components operationally intact? YES NO NA
Are all employees safely positioned or have cleared the area? YES NO NA
Have all affected employees been notified that the lockout or tag out devices
YES NO NA
have been removed before the equipment started?
Have lockout or tag out devices been removed from the energy-isolating device
YES NO NA
by the employee who applied them?
EMPLOYEES
Are the employees knowledgeable about the Lockout/Tag out Procedures and
YES NO NA
their responsibilities?
Are affected employees notified when the procedure is being used? YES NO NA
Have affected employees been trained to recognize when the procedure is being
used and instructed not to remove lockout/tag out devices or start de-energized YES NO NA
equipment?
LOCKOUT/TAG OUT DEVICES
Are LOTO devices manufactured from durable materials to stand the industrial
YES NO NA
environment of their use?
Are they substantial enough to prevent removal without the use of excessive
YES NO NA
force?
Do they clearly identify the employee who installed the device? (Color code) YES NO NA
APPLYING LOTO DEVICES
Have all sources of power been checked before shutting down the equipment? YES NO NA
Are all effective employees notified that you are ready to start a LOTO
YES NO NA
procedure?
Is the equipment stopped by following its normal shutdown procedure? YES NO NA
Is the equipment isolated by turning off the energy at the main power source? YES NO NA
Are lock and appropriate lockout device (tags) applied to each energy isolating YES NO NA
device?
Has the power been shut off and verified? YES NO NA
REMOVING LOTO DEVICES
Are all tools removed and machine guards replaced? YES NO NA
Are all employees cleared off the machine? YES NO NA
Are the LOTO devices removed by the person who applied them? YES NO NA
Are all affected employees notified that LOTO devices have been removed? YES NO NA
Is energy restored properly? YES NO NA
Recommendations

APPROVAL (name and signature)


Inspector: Date:
EHS : Date:

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