Periodic Inspection Certification for LOTO Procedures
This procedure establishes the minimum annual inspection requirements for the lockout of energy isolating devices whenever maintenance or servicing is done on machines or equipment. It shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources and locked out before employees perform any servicing or maintenance where the unexpected energizing or start-up of the machine or equipment or release of stored energy could cause injury.
MaintainX
07/26/2022
Periodic Inspection Certification for LOTO Procedures
This procedure establishes the minimum annual inspection requirements for the lockout of energy isolating devices whenever maintenance or servicing is done on machines or equipment. It shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources and locked out before employees perform any servicing or maintenance where the unexpected energizing or start-up of the machine or equipment or release of stored energy could cause injury.
DATE OF INSPECTION:
INSPECTOR:
SIGNATURE:
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Machine or equipment on which lockout / tagout procedures were performed:
Employee(s) performing the lockout / tagout procedures:
Employee Name (Please Print)
Employee Signature
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Were all the lockout / tagout procedures performed correctly?
Comments on improper lockout / tagout procedures being used (ex. list improper procedures being used that require retraining for the employee or modification of procedures):
Source: MaintainX (Community Member)