HYD47852GH / Wellington Industrial Works / 9 May 2018 / Robbie McPhee
Equipment Serial #
Wellington Industrial Works
9th May, 2018
9:33 AM AEST
Nature of work
Take a photo of the equipment/machinery
Hazardous energy sources
Purpose of Lockout Tagout procedure
Servicing or equipment maintenance
Employees involved in the LOTO
1. Mark Philips
2. Steve Rogers
3. Alvin Peters
Have nonessential items (e.g., tools, spare parts) been removed from the work area?
Area is clean with no unnecessary tools present.
Are all of the machine or equipment components operationally intact?
Are all employees safely positioned or have cleared the area?
Billy Smith, the supervisor, ensured that all employees have cleared off the area.
Have all affected employees been notified that the lockout or tagout devices have been removed before the equipment started?
Have lockout or tagout devices been removed from the energy-isolating device by the employee who applied them?
Are the employees knowledgeable about the Lockout/Tagout Procedures and their responsibilities?
Are affected employees notified when the procedure is being used?
Have affected employees been trained to recognize when the procedure is being used and instructed not to remove lockout/tagout devices or start de-energized equipment?
Are LOTO devices manufactured from durable materials to stand the industrial environment of their use?
Are they substantial enough to prevent removal without the use of excessive force?
Applying LOTO devices
Have all sources of power been checked before shutting down the equipment?
Are all effective employees notified that you are ready to start a LOTO procedure?
Is the equipment stopped by following its normal shutdown procedure?
Is the equipment isolated by turning off the energy at the main power source?
Are lock and appropriate lockout device (tags) applied to each energy isolating device?
Great locking device.
REFERENCE: Proper lockout and tagout device attached to the power source of the isolated device.
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]
Has the power been shut off and verified?
Removing LOTO devices
Are all tools removed and machine guards replaced?
Are all employees cleared off the machine?
Are the LOTO devices removed by the person who applied them?
Are all affected employees notified that LOTO devices have been removed?
Is energy restored properly?
1. Ensure that lockout or tagout devices are only used to control energy.
2. Do not forget to write the name of the person who applied the LOTO device.
3. Test the power source twice to make sure it is turned off properly.
4. Always conduct an inspection whenever servicing and maintenance are to be conducted.
5. Be knowledgeable about the LOTO procedure and the hazardous energy present in your area.