华体会

No

Sample energy control (lockout/tagout) checklist

Instructions

This worksheet is designed to provide a basic starting point to evaluate compliance with the OSHA lockout/tagout standard 29 CFR 1910.147. Additional requirements and information can be found on the OSHA website at .

DOES YOUR COMPANY

COMPLETED?

 

ACTIONS/COMMENTS

YES

NO

Have a written lockout/tagout program tailored to your facilities needs/exposures?

      

LOTO Program cover the additional requirements of the regulation as necessary?

  • Testing machines
  • Group lockout
  • Shift/personnel changes
  • Outside contractors
      

Identify hazard energy sources for each machine or group of machines?

      

Have written machine specific procedures for all equipment or machines where the release of energy could occur?

      

Issued authorized personnel with locks, keys and tags for use in lockout operations.

      

Conduct initial training of employees?

  • Authorized
  • Affected
  • Others
      

Certify the training that identifies each employee by name and date of training?

      

Set up a procedure for retraining employees on lockout/tagout as needed?

      

Conduct an annual inspection of all authorized employees on lockout/ tagout procedures?

      

Certify the annual inspection for each authorized employee by name; date; machine that was being locked out and the person doing the inspection?

      

 

To learn more about Hanover risk solutions, visit hanoverrisksolutions.com.

 

171-0958 (03/14)              LC12鈥�214

No

Sample energy control (lockout/tagout) checklist

Instructions

This worksheet is designed to provide a basic starting point to evaluate compliance with the OSHA lockout/tagout standard 29 CFR 1910.147. Additional requirements and information can be found on the OSHA website at .

DOES YOUR COMPANY

COMPLETED?

 

ACTIONS/COMMENTS

YES

NO

Have a written lockout/tagout program tailored to your facilities needs/exposures?

      

LOTO Program cover the additional requirements of the regulation as necessary?

  • Testing machines
  • Group lockout
  • Shift/personnel changes
  • Outside contractors
      

Identify hazard energy sources for each machine or group of machines?

      

Have written machine specific procedures for all equipment or machines where the release of energy could occur?

      

Issued authorized personnel with locks, keys and tags for use in lockout operations.

      

Conduct initial training of employees?

  • Authorized
  • Affected
  • Others
      

Certify the training that identifies each employee by name and date of training?

      

Set up a procedure for retraining employees on lockout/tagout as needed?

      

Conduct an annual inspection of all authorized employees on lockout/ tagout procedures?

      

Certify the annual inspection for each authorized employee by name; date; machine that was being locked out and the person doing the inspection?

      

 

To learn more about Hanover risk solutions, visit hanoverrisksolutions.com.

 

171-0958 (03/14)              LC12鈥�214