Template

Fatal Risk Critical Control Verification - Stored Energy

by Gerald Visagie, from the Community

This checklist supports verification of critical controls for stored energy hazards in industrial and mining environments. It guides teams to identify energy sources, isolate and de‑energize systems, apply locks and tags (LOTOTO), account for all isolation points, and confirm zero energy via tryout steps. It also covers competency requirements, proper installation of guards, barriers, emergency stops, and pull cords, and ensures reinstallation before return to service. Includes sign‑off for accountability.

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Eliminate mistakes made by paper-based processes

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Confirm accountability and compliance with a digital log

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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
Control of Hazardous Energy LOTO Procedure
This machine specific control of hazardous energy template guides teams through Lockout Tagout. It includes a quick check to determine when LOTO is required, fields to document all energy sources, and step by step instructions to isolate, lock and tag, release stored energy, verify zero energy, perform service, and restart safely. It emphasizes enforcement, responsibilities, and OSHA aligned best practices.
by Ken Phillips, from the Community
Downloads: 50+
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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
Downloads: 20+
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Template
Critical Risk Inspection - Stored Energy
This stored energy critical risk inspection checklist helps teams identify, control, and document hazards related to hydraulic, pneumatic, electrical, mechanical, chemical, and gravitational energy. Use it to verify isolation and tagging procedures, confirm the use of personal danger and out of service tags, check availability of spare tags, and review group isolation practices and permits. Assess confirmation locks, information tags, equipment under test tagging, and vehicle isolator switches. Validate competency-based isolation training, removal of keys during work, and employee engagement on isolations. Record non-compliances, assign actions with owners and due dates, and forward to the safety department for follow-up and closure tracking.
by Lance Matthews, from the Community
Downloads: 20+
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Template
High Pressure Energy Release Checklist
Use this fatal risk critical control checklist to prevent uncontrolled high pressure energy release from pressure vessels and systems in mining. It guides teams through identifying energy sources, isolating and de-energizing equipment, verifying isolation points, checking gauges and fittings, inspecting for leaks, tagging stored energy, and managing transport. The template also covers high pressure injection response steps, first aid and escalation, and documentation including isolation confirmation certificates. Apply it to hydraulic, pneumatic, nitrogen, water and other pressurized systems to protect workers and ensure compliance with standards.
by Samantha Fellows, from the Community
Downloads: 20+
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Fatal Risk Critical Control Verification - Stored Energy

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Control of Hazardous Energy LOTO Procedure

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