Lockout/Tagout (LOTO) Procedure Template

Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________

How to Use This Template

Use this to create a machine- or equipment-specific energy-control procedure. Fill in every energy source and isolation point for the specific equipment, then have a qualified/authorized person verify it. Only authorized employees who are trained on this procedure may perform lockout/tagout. Keep the completed procedure with the equipment or in your LOTO program binder, and review it periodically (and whenever the equipment or its energy sources change). This template supports your written Lockout/Tagout Program — it does not replace it.

Equipment-Specific LOTO Procedure

Equipment / machine: [NAME / ID] Location: [LOCATION] Procedure #: [____] Authorized employees: [NAMES / ROLES]

1. Energy Sources to Control

2. Shutdown & Isolation Steps

1. Notify all affected employees that LOTO will be applied.
2. Shut down the equipment using normal stopping procedures.
3. Isolate every energy source listed above (open disconnects, close valves, etc.).
4. Apply locks and tags — each authorized employee applies their own lock and tag to each isolation device.
5. Release/restrain stored energy (capacitors, springs, hydraulic/pneumatic pressure, elevated parts, thermal).
6. Verify zero energy — attempt to start using normal controls (then return controls to off/neutral) and test with appropriate instruments to confirm de-energization ("test before touch").

3. Performing the Work

Work may begin only after zero-energy verification. Each authorized employee keeps control of their own lock for the duration of the task.

4. Restoring Energy (Removal)

1. Confirm the work is complete and tools/parts are accounted for.
2. Ensure all employees are clear of hazard areas.
3. Verify guards/components are reinstalled.
4. Each authorized employee removes only their own lock and tag.
5. Notify affected employees, then restore energy and return to service.

5. Group / Shift Transfer

[Describe group lockout (lock box) and shift-change procedures if applicable, so protection is continuous.]

6. Verification & Periodic Inspection

This procedure was reviewed/verified by a qualified person and is inspected at least periodically using the LOTO Audit Form. Verified by: [NAME] Date: [DATE]

Company Customization Needed

• Identify every energy source and isolation point for the specific equipment — do not leave generic entries.
• List your authorized employees and confirm their training is documented.
• Define your lock/tag standards, group lockout method, and shift-transfer process.
• Review and customize based on applicable federal, state, local, client, manufacturer, and project-specific requirements.
• Pair this with your written LOTO Program and periodic audits.

Last Reviewed / Last Updated

• Last Reviewed: 2026-06-29
• Last Updated: 2026-06-29
• Next Review Due: [SET DATE]

Disclaimer

This document is a general safety template and educational resource. It is not legal advice, does not replace a site-specific hazard assessment, and does not guarantee compliance with OSHA or any federal, state, or local requirement. Employers are responsible for reviewing, customizing, implementing, training employees on, and maintaining their own safety programs and records. Consult a qualified safety professional, legal counsel, or regulatory authority when needed.

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