Lockout/Tagout (LOTO) Consignment Form

The Lockout/Tagout (LOTO) Consignment Form is a 24-item inspection checklist you use to verify that industrial equipment is safely de-energized before anyone cleans, services, adjusts or sets it up. It applies during maintenance and servicing work on machinery and mobile equipment, where the unexpected release of energy or an accidental start-up can injure the people doing the work. Working through the form helps you manage risk, prevent hazards, and keep maintenance activities compliant with lockout and tagout requirements. The checklist is organised into three parts — an audit section, a set of lockout and tagout procedure checks, and a recommendations section. Each controlled question is answered on a simple Yes / No / N/A scale, so the completed form reads as a clear record of what was verified and where attention is still needed. > Lockout/tagout is only effective when each person working on the equipment holds their own lock and key, and when the isolation is confirmed before any work begins.

What a good LOTO process covers

A thorough process starts with isolating the equipment. Isolating means machinery and mobile equipment are de-energized, disengaged and locked out during cleaning, servicing, adjustment or setup operations whenever that is necessary. But de-energizing the main disconnect is not always enough. The checklist therefore asks you to identify and document any case where the power disconnect means does not also disconnect the electrical control circuit, to clearly identify and label all relevant electrical control panels and disconnects, and to put provisions in place so the control circuit can also be disconnected and locked out. Two controls sharpen this further. Locking the control circuits instead of the main disconnect switches is strictly prohibited. And where disconnected — for instance because a machine is impossible to shut down, lock and tag — a formally documented safe work procedure must be established and followed rigorously. The process also covers physical hardware and stored energy. Control valve handles on the equipment are expected to carry an integrated locking mechanism, and the lockout procedure requires you to release or block all stored energy — mechanical, hydraulic, pneumatic and similar — before the equipment is locked out for repair. Finally, the checklist covers the people doing the work and the way you know who is protected. Affected employees need access to personal safety padlocks with individually keyed locks, keep sole personal control of their keys while their locks are in use, and the employee exposed to the hazard is the only one who may place or remove their personal safety lock. You also need a reliable way to identify one or all of the employees working on locked-out equipment through their personal locks or their identification tags, and to maintain an adequate supply of accident prevention tags, labels and safety padlocks for all reasonably foreseeable repair emergencies.

Verifying the lockout before work begins

The value of a lockout is only realised once it is proven effective. That means employees verify the effectiveness of the lockout by attempting a start-up after ensuring no personnel are exposed to potential hazards, then immediately press the control circuit stop button right after confirming the security of the lockout. Verifying, starting and stopping in that order closes the loop between the isolation you believe you have made and the isolation that actually exists. One more situation deserves particular attention. When the operation, configuration or size of a machine requires the operator to leave the control station to install tools or perform other operations, and that part of the machine could move if accidentally activated, it must be separately locked or blocked. Treating the machine as a single isolation point is not enough when work carries you away from the controls. A safe work procedure should also cover the case where the equipment or lines cannot be shut down, locked and tagged at all. In that situation the checklist expects a formally documented safe work procedure that is rigorously followed, so that the risk is managed by an agreed method rather than by improvisation.

Recording the inspection

The form opens with the audit details — the date conducted, who prepared it, and the location — and closes with your recommendations, signature and the real inspection start and end times. Completing those fields turns a series of answers into a dated record that shows what was checked, what was found, and what should happen next. Answer each question as Yes, No or N/A. A No is not a failure of the form; it is the point at which you record a recommendation. Where a requirement is not yet met, describe the gap and the action needed in the recommendations section, so the next person who picks up the form knows exactly where to start.

Frequently Asked Questions

Use the audit questions to check each requirement, move through the lockout and tagout procedures, then record recommendations, a signature, and the actual start and end times.

Yes. You must release or block all stored energy — mechanical, hydraulic, pneumatic and similar — before the equipment is locked out for repair.

Yes. Each affected employee needs a personal safety padlock with an individually keyed lock, keeps sole personal control of their key while their lock is in use, and only the employee exposed to the hazard may place or remove their own lock.

Yes. After confirming no personnel are exposed, you attempt a start-up to verify the lockout is effective, then immediately press the control circuit stop button.

Written by

Arne Reis

Founder

Process optimizer with 25 years of expertise, focused on operational excellence in quality, maintenance, EHS, and commissioning. Emphasizes innovative solutions and top-quality standards.

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