Self-Inspection

Lockout/Tagout Procedures

 (click on title for the printable PDF)

 Date Inspected _____________ Date Completed _____________

 
Checklist

Needs to be Addressed

Yes N/A

Is all machinery or equipment capable of movement, required to be de-energized or disengaged and locked-out during cleaning, servicing, adjusting or setting up operations, whenever required?

               
In places where the power disconnecting means for equipment does not also disconnect the electrical control circuit:    
       Are the appropriate electrical enclosures identified?      

       Are means provided to assure the control circuit can also be disconnected and locked-out?

     
Is the locking-out of control circuits in lieu of locking-out main power disconnects prohibited?      
Do all equipment control-valve handles have a means for locking-out?        
Does the lockout policy require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment is locked-out for repairs?      

Are appropriate employees provided with individually keyed personal safety locks?

     

Does the equipment lockout procedure require employees to keep personal control of their key(s) while they have safety locks in use?

     
Who can remove a lockout tagout: Is it required that only the employee exposed to the hazard, place or remove the safety lock?      
Does the equipment lockout procedure require that employees check the safety of the lock-out by attempting a startup after making sure no one is exposed?      
Are employees instructed to always push the control circuit stop button immediately after checking the safety of the lock-out?      
Is there an equipment lockout practice provided to identify any or all employees who are working on locked-out equipment by their lockout lock or accompanying tags?      
Are a sufficient number of lockout tagout accidents preventative signs or tags and safety padlocks provided for any reasonably foreseeable repair emergency?      
When machine operations, configuration or size requires the operator to leave his or her control station to install tools or perform other operations, and that part of the machine could move if accidentally activated, is such element required to be separately locked or blocked out?      
In the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job procedure established and rigidly followed?      

This Control of Hazardous Energy Lockout Tagout Checklist is NOT all-inclusive. You should add to it as necessary or skip parts that are not applicable to your company.  Carefully consider each item as part of an equipment lockout procedure, and refer to OSHA standards on control of hazardous energy lockout tagout for complete and specific guidelines that may apply to your work environment and an appropriate lockout policy. This Control of Hazardous Energy Lockout Tagout list is typical for general industry, not construction or maritime. Additional economical training resources on Lockout Policy and Safe Job Procedure can be found here.

Additional information