Lockout/tagout checklist
Version 1 · https://conformata.io/checklists/manufacturing/lockout-tagout-checklist · Made with Conformata. Guidance, not legal advice; sources at https://conformata.io/checklists/manufacturing/lockout-tagout-checklist/sources
Lockout/tagout checklist
Free lockout/tagout checklist based on OSHA 29 CFR 1910.147: shutdown, isolation, stored energy, verification and release in order. Fill in or print.
How often: Every time a machine is serviced or maintained where unexpected start-up or release of stored energy could injure someone. The energy control procedure itself is inspected at least annually.
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Machine or equipment name and asset number *
Energy control procedure number or title used
Servicing or maintenance task *
Date and time the lockout or tagout was applied *
Energy control method *
Lockout (locks on every isolating device)Tagout (tags only: on devices that cannot accept a lock, or on lockable devices where your program shows tagout gives full employee protection)Lockout and tagout on different devices
The written energy control procedure for this machine is available at the job *
YesNoN/A
Energy sources on this machine *
ElectricalMechanical (moving parts, springs, flywheels)HydraulicPneumatic (compressed air)Gravity (raised parts or loads)Thermal (steam, hot surfaces)ChemicalOther
The authorized employee knows the type and size of each energy source, its hazards and how to control it *
YesNo
Affected employees were told before the lockout or tagout was applied *
YesNo
The site and any outside contractor have told each other their lockout or tagout procedures
YesNoN/A
The machine was stopped with its normal stopping procedure, without creating a new hazard *
YesNo
Every energy isolating device named in the procedure was found and operated to cut off its energy *
YesNo
A lock or tag is on each energy isolating device, placed by the authorized employee doing the work *
YesNo
Locks are used on every isolating device that can accept a lock *
YesNo
Each lock holds its isolating device in the safe or off position *
YesNoN/A
Where a tag is used on a lockable device, it is fastened at the point where the lock would go
YesNoN/A
Each lock and tag shows the name of the employee who applied it *
YesNo
Locks and tags are the site's standard energy control devices (matching color, shape or size) *
YesNo
Each tag carries a warning such as Do Not Start, Do Not Energize or Do Not Operate
YesNoN/A
Tags are attached with a non-reusable, self-locking tie with at least 50 lb unlocking strength
YesNoN/A
For crew work, each worker has put a personal lock or tag on the group lockbox or group device
YesNoN/A
Stored or residual energy has been relieved, disconnected, blocked or restrained *
YesNo
Where stored energy can build up again, isolation is re-checked until the work is finished
YesNoN/A
Before work started, the machine was tried with everyone clear and did not operate *
YesNo
Operating controls were returned to neutral or off after the start test *
YesNo
If locks were removed to test or position the machine, everything was shut down and relocked before work resumed
YesNoN/A
At any shift or crew change, lock protection passed from the off-going to the oncoming employees without a gap
YesNoN/A
Tools and nonessential items are removed and the machine's components are operationally intact *
YesNo
All employees are safely positioned or out of the machine area *
YesNo
Controls are in neutral before locks and tags come off *
YesNo
Who removed each lock or tag *
The employee who applied itAnother person, following the documented procedure for when the employee who applied it is not at the facilitySomeone else, without that procedure
Affected employees were told the devices were removed before the machine was restarted *
YesNo
Date and time the machine was released to service *
Notes, problems found and any deviation from the procedure
Authorized employee's signature
Sign the printed copy, or sign electronically in Conformata.
I applied and released energy control on this machine as recorded above.
Signature
Name and date
Checks on the energy control program behind this procedure. Fill these in when reviewing the record.
This procedure has had a periodic inspection within the last 12 months *
YesNo
Date of the last periodic inspection of this procedure
That inspection was done by an authorized employee who does not use this procedure
YesNo
The inspection record names the machine, date, employees included and the inspector
YesNo
Training records list each authorized employee on this job by name with training dates
YesNo
Run it with your team in Conformata
- Schedule it per site and assign it to the right people.
- Turn every failed check into a corrective action that someone else verifies.
- Keep signatures, photos and the full audit history across sites.
Answers on this page stay on this device; they are not transferred.
Frequently asked questions
What is the difference between lockout and tagout?
Lockout places a lock on the energy isolating device so that it and the equipment it controls cannot be operated until the lock is removed [13]. Tags are warning devices and do not provide the physical restraint of a lock [28]. Where the device can accept a lock, the program must use lockout unless the employer can show tagout provides full employee protection [16].
Is pressing the stop button or turning a selector switch enough?
How often do lockout/tagout procedures need to be inspected?
Can anyone else remove my lock?
Each device is removed by the employee who applied it [48]. The only exception is removal under the direction of the employer through a specific, documented procedure with training [49]. That procedure includes verifying the employee is not at the facility [50], making all reasonable efforts to contact them [51], and making sure they know before they resume work [52].
Built from 56 official sources
Every check traces to the text it is based on. Read the purpose, how to use it, the rules behind it, what it does not cover and every source.
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Guidance, not legal advice. It does not replace the law, the manufacturer's instructions or your organization's competent people, and completing it does not certify that work is safe.