LOCKOUT/TAGOUT CHECKLIST

LOCKOUT/TAGOUT CHECKLIST

Prior to beginning work on machinery, equipment, or systems requiring Lockout/Tagout, check each item. If there are items that are not applicable to the entry, mark them "N/A".

Job Site:
Date:
Time:
Foreman:
Exp. Date:
Exp. Time:

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hat
• Eye/Face Protection (type)
• Protective clothing (type)
• Gloves (type)
• Respirator (type)
• Fall protection / Other

SHUTDOWN & LOCKOUT

• Electrical lockout/tagout completed
• Valves closed, lockout/tagout completed
• Lines blinded/blocked off
• Lines disconnected
• Line bleeders open
• All hydraulic/pneumatic pressure released
• All other energy released and/or guarded (magnetic, spring, gravity, reactivity)
• Hot work permit completed
• System/area check for flammables/vapors
• Fire extinguisher on site/in area
• Barricade/Exclusion Zone markers in place
• Machine/Equipment/System users / other personnel notified

REACTIVATION

• Electrical/System reconnected
• Line blinds/block-offs removed
• Line breeders closed
• Guards reinstalled
• Tools/materials removed
• Machine/Equipment/System users / other personnel clear and safe
• Electrical lockout/tagout removed
• Valve(s) lockout/tagout removed

WORK TEAM

Print Initial

Foreman

Safety

Customer

JOB COMPLETED

Date:

Time: