Lockout / Tagout Verification
A lockout/tagout verification form: energy sources identified and isolated, locks and tags applied by name, zero-energy verified by test, and a sequenced return to service. Photographed and PDF'd. Free to start.
Use this template with your own crew
Start a free trial, open it in the builder, and send it to a technician today. No card required.
Start free trial →30 days free · no card · cancel yourself any time. No seat minimum.
Would rather ask a person first? Email us — a human answers.
What happens when it's submitted
- File the LOTO recordEmails a branded PDF
- Flag exception lock removalFlags for review · Notifies the office
- Flag unverified isolationsFlags for review · Notifies the office
Lockout / Tagout Verification, on a phone and as a PDF
Both panels are drawn from this template's actual fields, so they change when the form does. Sample values shown; branding and layout are yours to change in the PDF designer.
What's on the form
All of this is customizable to your process. Delete the fields you don't need, add the ones you do — and every lookup is powered by your customer list and your own data.
Equipment
- Site / customerRequiredcustomer lookup
- Site addressaccount field
- LOTO record numberRequiredtext
- DateRequireddate
- Authorized employee applying the lockoutRequiredemployee lookup
- Equipment / systemRequiredtext
- Equipment locationRequiredtext
- Location stampGPS stamp
- Work to be performedRequiredtextarea
- Group lockout with a lock boxRequiredtoggle
- Affected employees notified before isolationRequiredtoggle
Energy sources
- All of them, not just the obvious oneinstructions
- Energy sourcesrepeating section
- Stored and residual energy released, blocked, or restrainedRequiredtoggle
- How stored energy was controlledtextarea
Verification
- Try to start itinstructions
- Normal start attempted and equipment did not operateRequiredtoggle
- Operating controls returned to the off positionRequiredtoggle
- Absence of voltage or pressure verified with an instrumentRequireddropdown
- Reading recordedtext
- Zero energy verified byRequiredtext
- Verification timeRequiredtime
- Photo of the verificationphoto
- Workers protected by this lockoutrepeating section
Release to service
- Release in orderinstructions
- Work completeRequiredtoggle
- Tools and materials removed from the equipmentRequiredtoggle
- Guards and covers replacedRequiredtoggle
- All personnel clear of the equipmentRequiredtoggle
- Every lock removed by the person who applied itRequireddropdown
- Exception procedure detail and who authorized itConditionaltextarea
- Affected employees notified before restartRequiredtoggle
- Released to service atRequiredtime
- Authorized employee signatureRequiredsignature
- Supervisor signaturesignature
Use this template with your own crew
Start a free trial, open it in the builder, and send it to a technician today. No card required.
Start free trial →30 days free · no card · cancel yourself any time. No seat minimum.
Would rather ask a person first? Email us — a human answers.