LOTO (Lockout/Tagout) Confirmation Statement

Electrical

Yes
No
N / A

Steam

Yes
No
N / A

Cold/Tempered water

Yes
No
N / A

Hot Water

Yes
No
N / A

Chemical

Yes
No
N / A

Compressed Air

Yes
No
N / A

Seven Steps To Lock Out - Perform Steps In The Sequence Indicated

1) Notify all partners that LOTO must be performed

2) Authorized partner fully understands the scope of work to be performed and associated hazards

3) Shut machine down using normal shut down procedure. Ensure the machine is in the correct position and securely supported.

4) Disconnect / deactivate all energy sources and potential energy sources as indicated on the risk assessment

5) Affix lock out devices to applicable energy isolation devices using individually-assigned locks

6) Ensure all potential / stored energy is released or restrained as indicated in the risk assessment

7) Ensure that the equipment is disconnected from all energy sources. Ensure no partners are exposed to any hazards - then verify the isolation of the machine by following the normal start up procedure and attempting to restart the machine. Yell “clear” before attempting to restart the machine. Return operating control device to the neutral position after attempting restart.

1) Check the machine and immediate area to ensure all tools and non essential items have been removed, all guards are in place and that all essential operational components are intact.

2) Check around machine and immediate areas to ensure no partners will be at risk during startup.

3) Confirm the controls are in the neutral position to prevent an unintended start up.

4) Remove all lock out devices and reenergize the machine. Some forms of blocking may require start up to remove.

5) Notify all affected partners that servicing is complete and the machine is back in service.

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LOTO (Lockout/Tagout) Confirmation Statement

LOTO (Lockout/Tagout) Confirmation Statement

All Hazardous energy has been isolated using LOTO procedures?

Yes

N/A

All potential stored or residual energy has been relieved, disconnected, restrained, lowered, and/or otherwise rendered safe?

Yes

N/A

How-To Videos:

Indication of isolated energy sources

Electrical

Steam

Cold/Tempered water

Hot Water

Chemical

Compressed Air

Seven Steps To Lock Out - Perform Steps In The Sequence Indicated

1) Notify all partners that LOTO must be performed

2) Authorized partner fully understands the scope of work to be performed and associated hazards

3) Shut machine down using normal shut down procedure. Ensure the machine is in the correct position and securely supported.

4) Disconnect / deactivate all energy sources and potential energy sources as indicated on the risk assessment

5) Affix lock out devices to applicable energy isolation devices using individually-assigned locks

6) Ensure all potential / stored energy is released or restrained as indicated in the risk assessment

Restoring To Service - Perform Steps In The Sequence Indicated

1) Check the machine and immediate area to ensure all tools and non essential items have been removed, all guards are in place and that all essential operational components are intact.

2) Check around machine and immediate areas to ensure no partners will be at risk during startup.

3) Confirm the controls are in the neutral position to prevent an unintended start up.

4) Remove all lock out devices and reenergize the machine. Some forms of blocking may require start up to remove.

5) Notify all affected partners that servicing is complete and the machine is back in service.