Template

AGL 2022 Isolation Certificate Template

by jay hammond, from the Community

10+

This AGL 2022 Isolation Certificate template helps teams record and control electrical isolation for maintenance and construction work. Capture site, client, and work details, identify the equipment or circuit to be isolated, and note time and location of isolation. Document safety locks and caution notices, and verify completion through visual, insulation resistance, and R1 and R2 continuity tests. Record re energisation details and obtain engineer and supervisor signatures to confirm approvals and safe return to service.

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Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
High Risk Audit - Isolation Test Checklist
Use this high risk isolation audit to assess compliance with isolation and lockout procedures on construction and electrical works. Check that workers are identified on danger or out of service tags, understand the procedure, and can identify hazardous energy sources. Verify methods to isolate, test effectiveness, and manage multiple isolation points. Confirm TRA and permit requirements, assignment of an isolation coordinator, and adherence to site procedures. Ensure communication with nearby workers, completion checks before re-energizing, and documentation of observations and corrective actions.
by JUSTINE YOUL, from the Community
Downloads: 10+
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Template
High Risk Isolation Audit Checklist
This high risk isolation audit checklist helps teams verify hazardous energy controls and validate isolation effectiveness on complex worksites. It covers identifying energy sources, selecting proper isolation methods, testing single and multiple isolation points, and documenting TRA and permit requirements. The template supports assigning an isolation coordinator, communicating activities to nearby workers, and ensuring all tools are cleared and personnel are safe before re energising equipment. Use it to improve compliance and reduce risk during electrical, mechanical, and commissioning tasks.
by JUSTINE YOUL, from the Community
Downloads: 10+
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Template
Hazardous Energy Isolation Checklist
Use this hazardous energy isolation checklist to plan and verify lockout, tagout, and isolation steps before maintenance or repair. Capture site, auditor, and location details; verify risk assessments; complete LOTO sheets; confirm trade and personal locks; place tags and signage; establish exclusion zones; and verify systems are de-energized at the power source. Record live work controls, stop-work actions, and final sign-offs to keep teams compliant and safe.
by Jared Swenson, from the Community
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Template
Isolation of Hazardous Energy Procedure Checklist
Use this isolation of hazardous energy procedure checklist to standardise lockout tagout across high-risk worksites. It covers planning and risk assessment, permits to work, single and multi-point isolation, mobile plant isolation, de-energisation of stored energy, and test for dead. It details personal danger locks and tags, lockboxes, shift handover, emergency planning, and lost key or missing person scenarios. It sets competency, training, consultation, and monitoring requirements to ensure safe re-energisation and compliance with standards.
by Saul Chambers, from the Community
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AGL 2022 Isolation Certificate Template

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