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Lockout/Tagout Inspection

A periodic checklist to confirm that authorized workers apply the energy lockout/tagout procedure correctly. It logs the equipment checked, answers to each control point, comments, and signatures from both employee and inspector.

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In the Claude connectors directory

Department*

Equipment Type and Serial Number*

Inspection Conducted By*

Date*

Authorized Employee Name*

Has the employee been trained in the procedure?

Yes No Not applicable

Does the authorized employee know where the written procedure is kept?

Yes No Not applicable

Does the authorized employee have access to the procedure?

Yes No Not applicable

Are affected employees notified when the procedure is in use?

Yes No Not applicable

Have affected employees been trained to recognize when the procedure is in use and told not to remove LOTO devices or start de-energized equipment?

Yes No Not applicable

Did the authorized employee lock out all energy sources?

Yes No Not applicable

Did the authorized employees verify the equipment was de-energized?

Yes No Not applicable

Did the authorized employee follow the lockout/tagout procedure?

Yes No Not applicable

Does the authorized employee show the correct steps for placing, removing and transferring LOTO devices?

Yes No Not applicable

Does the lockout/tagout procedure adequately protect employees?

Yes No Not applicable

LOTO device removal

Was the machine or equipment inspected to confirm it is operationally intact?

Yes No Not applicable

Are all employees safely positioned and flammable liquids stored properly?

Yes No Not applicable

Were affected employees and others in the area told the LOTO devices have been removed?

Yes No Not applicable

Responsibility review

If this is a lockout procedure, did the inspector review responsibilities with authorized and affected employees?

Yes No Not applicable

Comments

Retraining

Does the authorized employee need retraining?

Yes No Not applicable

Comments

Signatures

Authorized Employee Signature and Employee Number

Sign here

Inspector Signature and Employee Number

Sign here

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