Template: Lockout-Tagout-System
A checklist for the lockout/tagout procedure used before maintenance and repair of industrial equipment and heavy machinery. It ensures that workers performing the tasks are not endangered by unintended equipment startup. Use this template to record the type of work to be performed, associated hazards, and personnel involved in the procedure.
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How to Use This Checklist
- **Record the basics.** Enter the date the audit was conducted, who prepared it, and the location of the equipment or work area. These fields identify the procedure and make the record traceable.
- **Confirm isolation and lockout.** Work through the questions on whether all moving machines or equipment are disconnected from power and locked out when required during cleaning, maintenance, adjustment, or setup. Check whether additional lockout is required when the equipment disconnect device does not also isolate the electrical control circuit, and how electrical enclosures are identified—by labels, tags, color coding, or other means.
- **Verify control circuits and control valves.** Confirm that the control circuit can also be isolated and locked out, that locking out control circuits instead of main disconnect switches is prohibited, and that all control valve handles are equipped with a locking device.
- **Account for stored energy.** Note how many stored energy sources—mechanical, hydraulic, pneumatic, and similar—need to be released or blocked before lockout.
- **Check locks, keys, and personal control.** Confirm that employees are equipped with individually coded personal safety locks, that they maintain personal control of their keys while using safety locks, and that only the employee exposed to the hazard applies or removes the safety lock.
- **Confirm identification and availability of equipment.** Ensure there is a way to identify individual employees working on locked-out equipment by their locks or tags, and that sufficient warning tags and safety padlocks are available for every reasonably foreseeable repair emergency.
- **Review the verification step.** Rate the effectiveness of the lockout verification process from 1 to 10 and confirm that employees are instructed to immediately press the emergency stop button after verifying safe lockout.
- **Handle special situations.** Where machine operation requires the operator to leave their position to install accessories and that part could move if accidentally activated, confirm that it is separately locked or blocked. For equipment that cannot be locked out, describe the safe work procedure established for it.
- **Close out the audit.** Enter your recommendations, add your signature, and record the finished time and the inspection's actual start and end dates.
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What lockout/tagout is and why it matters
Lockout/tagout is the practice of isolating equipment from all energy sources and securing the isolation before anyone performs cleaning, maintenance, adjustment, or setup work. It exists to prevent unintended equipment startup and the release of stored energy while a worker is exposed to the machinery. The checklist covers both the electrical supply and the control circuits and valves that can otherwise let equipment move, along with mechanical, hydraulic, and pneumatic energy that must be released or blocked. It also addresses the human side of the system: individually coded personal safety locks, personal control of keys, and warning tags that identify who is working on the equipment.
What a good lockout/tagout system covers
A complete system goes beyond switching off the main disconnect. It accounts for control circuits that must be isolated separately when the disconnect device does not also isolate them, and it treats locking out control circuits instead of main disconnect switches as prohibited. Control valve handles must be equipped with a locking device. Electrical enclosures need to be identified—by labels, tags, color coding, or another method—so the correct isolation points are clear. Every stored energy source, whether mechanical, hydraulic, or pneumatic, must be released or blocked before lockout is complete. The system also defines who may act: employees are equipped with individually coded personal safety locks, they keep personal control of their keys, and only the employee exposed to the hazard applies or removes the safety lock. Locks and tags must make it possible to identify individual employees working on the equipment. Sufficient warning tags and safety padlocks must be available for every reasonably foreseeable repair emergency.
Special situations and safe work procedures
Not every hazard fits the standard sequence. If machine operation requires the operator to leave their position to install accessories, and that part could move if accidentally activated, it must be separately locked or blocked. For equipment that cannot be locked out, a safe work procedure must be established and described in the record. The checklist captures these cases alongside the routine ones so that no equipment is left without a defined approach.
How to carry it out
The checklist is organised into an audit, the lockout/tagout procedure itself, and a recommendations section. The audit records the date, who prepared it, and the location. The procedure section works through the isolation, locking, identification, and verification questions described above, including a rating of how effective the lockout verification process is on a scale of 1 to 10 and confirmation that employees are instructed to immediately press the emergency stop button after verifying safe lockout. The recommendations section collects your written recommendations, a signature, the finished time, and the inspection's actual start and end dates. Together these fields produce a record of what was checked, what hazards and personnel were involved, and what remains to be improved.
Using the template
Treat the checklist as the tool that supports the procedure, not a substitute for it. Answer each question against what is actually in place at the equipment, using the available responses of Yes, No, and N/A, and record identification methods as they are used on site. Use the free-text fields to describe the work, the hazards, the personnel involved, and any safe work procedure for equipment that cannot be locked out. Where a question does not apply, mark it N/A rather than leaving it blank.
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