Lockout/Tagout (LOTO) Procedure

Per 29 CFR 1910.147 — The Control of Hazardous Energy | EHS Community Template

⚠ WARNING: This procedure must be completed for each individual piece of equipment before servicing or maintenance work begins. Only authorized employees trained in LOTO may perform this procedure. Only the employee who applied a lockout/tagout device may remove it.

SECTION 1 — EQUIPMENT IDENTIFICATION

Equipment Name / Description

Equipment ID / Asset Number

Location / Department

Manufacturer / Model

Procedure Written By

Date

SECTION 2 — ENERGY SOURCES INVENTORY

Energy Type	Energy Source Location	Isolation Device	Lock / Tag Type	Stored Energy Release Method
Electrical
Pneumatic
Hydraulic
Mechanical / Gravity
Thermal
Chemical
Other: ___________

SECTION 3 — REQUIRED PPE FOR THIS PROCEDURE

PPE Required

Additional Permits Required (e.g., Confined Space, Hot Work)

SECTION 4 — LOCKOUT/TAGOUT SEQUENCE (Shutdown)

Notify all affected employees that equipment will be shut down for servicing.

Identify all energy sources listed in Section 2 above.

Shut down equipment using normal stopping procedure:

Isolate each energy source at its control/isolation point (list order below):

Apply LOTO device(s) to each isolation point. Each authorized employee applies their personal lock.

Release / restrain stored energy:

Verify the equipment is de-energized. Attempt to start. Verify zero energy state:

SECTION 5 — RESTORATION SEQUENCE (Re-energization)

Inspect the work area — ensure all workers are clear, tools removed, guards replaced.

Notify all affected employees that equipment will be re-energized.

Remove each lockout/tagout device. Only the employee who applied the device may remove it.

Re-energize equipment in the reverse order of isolation:

Confirm normal equipment operation and notify affected employees that servicing is complete.

SECTION 6 — ANNUAL INSPECTION CERTIFICATION

Inspection Date	Inspected By (Name / Title)	Equipment Verified Operating Correctly	Deficiencies Noted	Corrective Action

EHS Manager / Safety Officer Signature

Printed Name & Title

Date Approved

Next Review Date

This template is provided for educational purposes by EHS Community (ehscommunity.com). It does not constitute legal advice. Reference: 29 CFR 1910.147 — Control of Hazardous Energy (Lockout/Tagout).