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OSHA - LOTO Print to Fill Form

MaintainX
10/24/2021

OSHA - LOTO Print to Fill Form

29 steps
  • Requirements:

  • General Information:

  • This is a Microsoft Word file that can be printed and filled out.

  • The content is arranged in a table format and can be edited in Microsoft Word.

  • This form is made to print and fill out by hand for those not comfortable filling it out on the computer.

  • Instructions:

  • LOTO PROCEDURES

  • Company Name

  • Lock out/Tag Out procedures are to be completed before any service or maintenance work on equipment or machinery, and/or before entry into any grain bin or other area where operating equipment poses a hazard to the entrant. Failure to follow proper lockout-tag out procedures may result in disciplinary action up to and including termination.

  • General Lockout Steps

  • Steps & Instructions

  • Additional Information

  • Lockout Release Steps

  • Steps & Instructions

  • SPECIFIC LOTO INSTRUCTIONS

  • Company Name

  • Equipment ID:

  • Description:

  • Facility:

  • Location:

  • Date Created:

  • Person:

  • Date Revised:

  • Person:

  • # 1 Lockout Points Identify where the lock out points are located.

  • Picture of lockout points goes here.

    Add or drag pictures
  • Picture of lockout points goes here.

    Add or drag pictures
  • # 2 Lockout Instructions Follow the lock out instructions below.

  • Energy Source

  • Device used to De-energize

  • Location

  • Method

  • Try Out Check to Verify Equipment is De-energized

  • SPECIAL INSTRUCTIONS

  • 1.

  • 2.

  • 3.

  • Reference: Typical minimal lockout procedure – 29 CFR 1910.147 App. A Enforcement: Failure to follow proper lockout-tag out procedures may result in disciplinary action up to and including termination.

  • SAFETY IS YOUR RESPONSIBILITY – LOCK IT OUT!

Please note that any procedure, checklist, or other document available in the MaintainX Global Procedure Library is provided for general education and information only and does not constitute legal, medical, or financial advice. MaintainX makes the materials available AS IS and AS PROVIDED, without warranties of any kind. By downloading or using any such materials, you assume the risk that they may not be appropriate for your specific situation and agree that you are solely responsible for any such use, including compliance with applicable law and with meeting any conditions of product warranties.