Back

Hazardous Energy Control Procedures during LOTO

This procedure checklist is to protect employees from injuries while servicing and maintaining equipment.
MaintainX
07/26/2022

Hazardous Energy Control Procedures during LOTO

31 steps
This procedure checklist is to protect employees from injuries while servicing and maintaining equipment.
  • Name of employee exposed to the hazard:

  • Machine / Equipment on which the task is being performed:

  • Servicing / Maintenance task being performed:

  • Frequency in which the employee performs the task:

  • times per (days, weeks, months, etc.)

  • Duration for which the employee has performed the task: _____ hour/day/week

  • Hazard to which the employee is exposed when performing this task:

  • caught in:

  • crushed by:

  • struck by:

  • thrown from:

  • contact with:

  • other:

  • Energy source which exposes the employee to a hazard:

  • Magnitude of the energy source:

  • Potential Injury associated with the improper isolation of energy:

  • Crushed

  • Fractured

  • Amputated

  • Lacerated

  • Punctured

  • Burns

  • Air Embolism

  • Death

  • Electric Shock

  • Other

  • Means of Isolating the Energy Source (Procedures Used)

  • Location:

  • Method:

  • If machine / equipment is not capable of lockout when was it installed, renovated, modified, or repaired (major)?

    • Yes
    • No
    • N / A
  • If Electrical, cord / plug (circle one);

    • Yes
    • No
    • N / A
  • Hazards discussed with exposed employee Mr. / Ms.

  • Remarks/Signed Statement (if documenting past exposure) Hazard reviewed with employer Mr. / Ms.

  • Remarks:

Source: MaintainX (Community Member)

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.