Template

Annual Inspection of Energy Control Procedures

Use this template to conduct the annual inspection of energy control procedures for lockout tagout. Capture the inspector, employee being inspected, and equipment, confirm written procedures are developed and followed, document deviations, specify corrective actions, and certify completion with date and signature. Created by Mountaire Farms and available in the SafetyCulture Public Library.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

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

Hazardous Energy Control Lockout Tagout Checklist

This Hazardous Energy Control (Lockout and Tagout) checklist aligns with AFI 91-203 and helps teams control hazardous energy during service and maintenance. It covers documented LOTO procedures, initial and recurring training plans, use of locks and tags to isolate energy, annual program inspections, availability of safety tags and locks, equipment-specific written procedures, personnel notifications before and after LOTO, knowledge of energy types and magnitudes, proper attachment of devices, shift-change continuity, current training records, and periodic self-inspections. Ideal for defense and industrial operations seeking safer work practices.

by 167th Wing Safety Office, from the Community

30+

Get

Template

Lockout/Tagout Periodic Assessment Checklist

This lockout/tagout periodic assessment checklist helps auditors verify compliance with energy control procedures. It covers notification of affected persons, availability and accuracy of written and diagrammed procedures, proper use of energy-isolating devices, locks, blocks, and pins, and verification by each authorized employee. Record deficiencies, corrective actions, countermeasures, and communication to affected team members. Capture inspector name, signature, date, and time.

by Chassity Jenkins, from the Community

10+

Get

Template

LOTO Monthly Audit Checklist

This Lockout Tagout (LOTO) monthly audit checklist helps EHS, maintenance, and operations teams verify that energy isolation procedures are correctly followed. Assess training currency, availability and identification of personal locks and tags, access to written procedures, shutdown steps, isolation of all energy sources, control of stored energy, verification testing, and proper removal and notification. Capture issues, corrective actions, and signatures to strengthen compliance and worker safety across industrial facilities.

by Dan Da Costa, from the Community

20+

Get

Template

Lockout/Tagout Periodic Inspection 403.1

Use this Lockout/Tagout periodic inspection checklist to verify compliance with OSHA 1910.147 and your site procedures. Assess employee knowledge of the full LOTO process, including notification, shutdown, energy isolation, lock and tag application, stored energy release, and verification of zero energy state. Review removal steps, confirm posting and accuracy of equipment-specific procedures, check labeling and arc flash information, and document findings and corrective actions with sign-offs from the observed employee and auditor.

by Brady Heck, from the Community

10+

Get

Template

Hazardous Energy Control Annual Report Checklist

Ensure compliance with hazardous energy control requirements using this annual report checklist. Built around OSHA 29 CFR 1910.147 and DAFMAN 91-203, it guides authorized personnel through self-inspections and outside inspections, verification of LOTO procedures, training currency, group and complex lockout planning, shift-change procedures, and documentation. Capture equipment IDs, confirm availability of energy-isolating devices, and document out-briefs and follow-up actions to maintain a robust lockout tagout program and continuous safety improvement.

by Safety Office, from the Community

Get

Template

Hazardous Energy Control Lockout and Tagout Checklist

This Lockout Tagout checklist supports hazardous energy control for machinery and equipment. It guides teams to confirm documented LOTO procedures, training plans, availability and correct use of locks and tags, and annual program inspections. It covers equipment specific procedures during servicing and maintenance, worker notifications before and after LOTO, supervisor and operator knowledge of energy types and hazards, proper attachment of isolating devices in safe positions, replacement of service locks when maintenance begins, shift change continuity, recurring training documentation, and periodic self inspections. Use it to prevent unexpected start up and protect workers.

by Trevor McMartin, from the Community

60+

Get