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Lockout Tagout Checklist

Use this checklist before you repair industrial equipment. Record the kind of work, dangerous energy sources, and the workers involved in the procedure. Do a site walkthrough to assure that the area is free from unnecessary tools and verify if employees are qualified to perform a procedure. After that, check the quality and effectiveness of LOTO devices being used. Assess if the step-by-step method was followed when implementing and removing LOTO devices. Finally, rate the overall lockout tagout process and give recommendations with the use of this template.

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Lockout Tagout Checklist


General Information

Kind of work
Workers involved in the LOTO:
Dangerous energy sources:
Purpose of this procedure
Attach a photo of the equipment/machinery/device:

Area Inspection

Have lockout or tagout devices been replaced from the energy-isolating device by the worker who used them?
Are all of the machine or equipment parts operationally functional?
Are all workers safely located or have cleared the area?
Have unimportant objects (e.g., tools, spare parts) been removed from the workspace?
Have all concerned employees been informed that the lockout or tagout devices have been removed before the machine started?


Have affected workers been trained to know when the procedure is being used and directed not to remove lockout/tagout devices or start de-energised equipment?
Are concerned employees informed when the procedure is being used?
Are the workers informed about the Lockout/Tagout procedures and their duties?

Lockout/Tagout Devices

Are they substantial enough to prevent removal without the application of excessive force?
Do they certainly identify the worker who established the device?
Are LOTO devices produced from durable supplies to stand the industrial environment of their application?

Applying LOTO devices

Are all active employees told that you are ready to start the LOTO procedure?
Is the equipment stopped by its standard shutdown procedure?
Is the equipment separated by turning off the energy at the central power source?
Have all sources of power been reviewed before turning off the machine?
Has the power been turned off and verified?
Are lock and proper lockout device (tags) used to each energy-isolating device?
Reference-image: Proper lockout and tagout device connected to the power source of the separate device. [This is an example of how you can use Lumiform to add reference images showing the best practice in your templates to help with inspections]

Removing LOTO devices

Are all tools removed and all machine guards replaced?
Are all workers cleared off the machine?
Is the LOTO equipment removed by the same person who applied them?
Are all concerned employees informed that LOTO devices have been removed?
Is energy restored appropriately?


Do you have any further recommendations?
Name and signature of the inspector:
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