Lockout/Tagout (LOTO) Program Audit — Free Template

Program covers servicing and maintenance where unexpected start-up could injure

Scope should include set-up, clearing jams, cleaning, lubricating, and any task requiring bypass of a guard or placement into a danger zone.

Program is current and reviewed when equipment or processes change

Program is available to affected employees

Procedures contain a specific statement of their intended use

Required by 1910.147(c)(4)(ii)(A) and a frequent citation for generic procedures. The procedure should name the machine or task it covers, not read as a generic template that could apply to anything.

Procedures state the steps to shut down, isolate, block, and secure the equipment

Procedures identify the type and magnitude of every energy source

Electrical, hydraulic, pneumatic, mechanical, thermal, chemical, and gravity / stored energy.

Procedures specify placement, removal, and transfer of lockout/tagout devices

Procedures specify how to verify the energy is controlled (zero-energy test)

Devices are durable and substantial enough to prevent removal without excessive force

Tags must be non-reusable, attachable by hand, self-locking, and not removable inadvertently.

Devices are standardized by color, shape, or size

Each device identifies the employee who applied it

Lockout/tagout devices are used only for controlling energy

Not used as toolbox or locker locks or for any other purpose.

Where tagout is used instead of lockout, equivalent protection is provided

Mark N/A if all energy-isolating devices are locked out. Tagout-only requires additional measures (e.g., removing an isolating element, blocking a control switch).

Inspection is performed by an authorized employee not using the procedure inspected

Inspection reviews each authorized employee's responsibilities under the procedure

Where tagout is used, the periodic inspection also reviews responsibilities with affected employees

Mark N/A if your facility uses lockout exclusively. Required by 1910.147(c)(6)(i)(D) whenever tagout is used in place of lockout — affected employees are pulled into the inspection review because tagout depends more on the broader workforce understanding the warning.

The employer certifies the inspection

Certification must identify the machine, the date, the employees included, and the person who performed the inspection.

Deviations or inadequacies found in inspection are corrected

Affected employees are trained on the purpose and use of the procedures

Affected employees operate the equipment or work nearby but do not perform the lockout.

Other employees are instructed not to restart locked-out equipment

Retraining is provided when jobs, equipment, or procedures change

Also required when a periodic inspection reveals deviations or inadequate knowledge.

Training is documented and certification is current

Certification includes each employee's name and the date of the most recent training.

Equipment is shut down using an orderly procedure

All energy-isolating devices are operated to isolate the equipment

Each authorized employee applies their own lockout/tagout device

Stored or residual energy is relieved, disconnected, or restrainedCritical

Capacitors, springs, hydraulic/pneumatic pressure, elevated parts, steam, and rotating flywheels must be rendered safe.

Zero-energy state is verified before work beginsCritical

Try-to-start at the controls and/or test for voltage. Return controls to neutral/off afterward.

Procedures require re-verification of zero-energy state when the machine is left unattended

Common fatality scenario: a worker returns from a break, lunch, or shift change and resumes work without re-testing isolation. The written procedure should require try-to-start and/or voltage test again before re-entering the danger zone.

On release, the area is checked, employees are clear, and devices are removed by the applier

Tools removed, guards reinstalled, employees safely positioned, affected employees notified before energy is restored.

Group lockout gives each authorized employee protection equivalent to individual lockout

e.g., a group lockbox where each worker applies a personal lock and holds the key while exposed.

Energy control continuity is maintained across shift or personnel changes

An orderly transfer of devices between off-going and on-coming authorized employees, with no gap in protection.

Are outside contractors used for servicing or maintenance?

The on-site employer and the contractor inform each other of their LOTO procedures

Notes, corrective actions, and follow-up items

Auditor signature

Reviewed by (manager name and title)

Audit date