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Machine specific lockout tagout procedure template

Machine specific lockout tagout procedure template

Customize lockout tagout procedures for specific machines with this detailed template. It outlines tailored steps for isolating energy sources unique to each machine.

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Machine specific lockout tagout procedure template

Customize lockout tagout procedures for specific machines with this detailed template. It outlines tailored steps for isolating energy sources unique to each machine.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

A machine specific lockout tagout procedure template ensures that maintenance and repair work on equipment happens safely, with hazardous energy sources controlled. This template gives you an organized format for documenting each machine’s unique energy isolation points and lockout steps, creating a clear roadmap for technicians.

For example, when your maintenance team needs to service a complex hydraulic press with multiple energy sources, this template helps identify and document every power point that needs isolation, preventing accidental startup during maintenance. According to OSHA, proper lockout/tagout compliance prevents around 120 fatalities and 50,000 injuries in the US every year.

Related categories

  • Health and safety management templates
  • Facility management templates
  • Manufacturing templates
  • Workplace safety templates
Preview of the template
Machine Information
Machine Name
Location
Department
Function
Energy Source Identification
Electrical
Hydraulic
Pneumatic
Mechanical
Other
Lockout Procedure
Notify Affected Employees
Shut Down Machine
Isolate All Energy Sources
Apply Lockout Devices
Verify Isolation of Energy

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

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Lockout tagout softwareEquipment maintenance software Electrician AppForklift inspection app
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Other resources

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4 types of predictive maintenance for your businessHow to perform safety inspectionsThe importance of personal protective equipment (PPE) in workplace safety4 benefits of safety management and how to communicate them

Frequently asked questions

How can I identify all energy sources for my machine specific LOTO procedure?

First, review equipment manuals and schematics to identify primary and secondary energy sources. Consult with equipment operators and maintenance personnel who work with the machine regularly. Document all electrical disconnects, hydraulic and pneumatic shutoffs, mechanical energy (like springs or counterweights), and any stored energy that could cause movement. Remember to consider less obvious sources like capacitors or accumulators.

What should I do if my machine has multiple energy sources that need different lockout devices?

Document each energy source separately in your procedure with specific instructions for the appropriate lockout device. Ensure your lockout kit contains all necessary devices, and train employees on proper application for each energy type. This comprehensive approach ensures complete isolation before maintenance begins

How do I address partial shutdown procedures in my machine specific LOTO template?

For equipment where partial energy isolation is possible, clearly document which sections remain energized and establish boundary markings. Include additional precautions for working near energized components and specify when partial shutdown is acceptable versus when complete lockout is required. The procedure should address each energy source separately and include verification steps for both isolated and energized sections.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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