Run Lockout / Tagout Periodic Audit — Free

Inspection Details

Inspection date and time recorded

Equipment, machine, or process covered by this audit identified

Energy control procedure / SOP reference documented

Inspector is authorized to perform periodic inspection and is not using the procedure being audited critical (required)

Yes No N/A

Employee & Procedure Verification

Authorized employee(s) observed performing the full lockout/tagout sequence critical (required)

Yes No N/A

Correct sequence followed: notify affected employees before shutdown critical (required)

Yes No N/A

Equipment shutdown performed using the documented procedure critical (required)

Yes No N/A

All energy-isolating devices identified and applied correctly critical (required)

Yes No N/A

Locks and tags applied by each authorized employee as required critical (required)

Yes No N/A

Stored or residual energy released, restrained, or otherwise controlled critical (required)

Yes No N/A

Verification Step

Verification step performed before work began critical (required)

Yes No N/A

Attempt to start, energize, or otherwise verify isolation completed safely critical (required)

Yes No N/A

Verification performed with zero-energy state confirmed before servicing critical (required)

Yes No N/A

Verification method matched the documented procedure for this equipment critical (required)

Yes No N/A

Restoration and Release from Lockout/Tagout

Work area cleared and nonessential items removed before re-energization critical (required)

Yes No N/A

Affected employees notified before locks/tags were removed and equipment re-energized critical (required)

Yes No N/A

Locks/tags removed only by the authorized employee who applied them or per documented exception critical (required)

Yes No N/A

Equipment restored to normal operating condition using the documented sequence

Yes No N/A

Findings and Corrective Actions

Deficiencies or non-conformances identified

Note (optional)

Corrective action required

Responsible person / department

Target completion date

Note (optional)

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Run: Lockout / Tagout Periodic Audit

Inspection Details

Employee & Procedure Verification

Verification Step

Restoration and Release from Lockout/Tagout

Findings and Corrective Actions

Get your results