Checklists : Energy Control (Lockout/Tagout) Checklist

ENERGY CONTROL (LOCKOUT/TAGOUT) CHECKLIST
Instructions: Use this worksheet to inspect your facility for compliance. A "No" answer indicates that corrective action is required to remedy the situation. Take action now.

Assessment Baseline Action/Comments
Do you have a written lockout/tagout program tailored to your facilities needs? Yes No

Does your program cover the additional requirements of the regulation as necessary?

  • testing machines
  • group lockout
  • shift/personnel changes
  • outside contractors
 Yes No
Has hazard energy sources been identified for each machine or group of machines? Yes No
Do you have written machine specific procedures for all equipment or machines where the release of energy could occur? Yes No
Have authorized personnel been issued locks, keys and tags for use in lockout operations. Yes No

Has initial training of employees been conducted?

  • authorized
  • affected
  • others
Yes No
Have you certified the training which identifies each employee by name and date of training? Yes No
Have you set up a procedure for retraining employees on lockout/tagout as needed? Yes No
Have you conducted an annual inspection of all authorized employees on lockout/tagout procedures? Yes No
Have you certified the annual inspection for each authorized employee by name date machine that was being locked out and the person doing the inspection? Yes No