Checklist template

Lockout and electrical safety for maintenance work

A ready-to-use checklist with 120 items in 6 sections, covering Procedures, Devices, Training, Electrical work, Verification, Records. Use it as-is in InspectLoop, or adapt it to your own standards in minutes.

  • 6 Sections
  • 120 Items
  • 97 Yes / No checks
  • 6 Scored ratings
  • 127 Points

Use this template How audits work

1. Procedures 19 items

  1. Machines on site that require a machine-specific lockout procedure Number
  2. Machines requiring a procedure that have none Number
  3. A written lockout program is available in the maintenance shop Yes / No 1 pt
  4. 5 machines sampled (for example an air handler, compactor, baler, dock leveler, boiler) each have a machine-specific procedure Yes / No 1 pt
  5. Each procedure lists every energy source of the machine (electrical, pneumatic, hydraulic, gravity, steam, stored) Yes / No 1 pt
  6. Each procedure gives the location of every isolation point by disconnect, breaker or valve number Yes / No 1 pt
  7. Each procedure states how stored energy is released (bleeding air, discharging capacitors, lowering raised parts) Yes / No 1 pt
  8. Each procedure states how to verify that the machine cannot start Yes / No 1 pt
  9. The procedure is posted at the machine or can be scanned from a label on it Yes / No 1 pt
  10. The program covers group lockout, with one lock per worker Yes / No 1 pt
  11. The program covers the handover of locks at shift change Yes / No 1 pt
  12. The program covers removal of a lock when its owner is absent, with a manager's authorization Yes / No 1 pt
  13. The program covers work by contractors on the site's equipment Yes / No 1 pt
  14. The program states when unplugging cord-and-plug equipment is enough Yes / No 1 pt
  15. The procedure for clearing a jam in the baler or compactor requires lockout, not only removing the key Yes / No 1 pt
  16. Equipment installed in the last 12 months has a procedure Yes / No 1 pt
  17. Disconnects in the field are labeled with the equipment they serve Yes / No 1 pt
  18. 3 breakers sampled control the circuits named in the panel directory Yes / No 1 pt
  19. Lockout procedures for the machines sampled Rating
    • Specific and complete for every machine 5 pts
    • Generic or incomplete for some machines 3 pts
    • Missing for most machines 1 pt

2. Devices 20 items

  1. Lockout locks available at the lockout station Number
  2. Locks found on equipment with no work in progress and no tag Number
  3. Each authorized technician has personally assigned locks Yes / No 1 pt
  4. Each lock has a single key, held by the worker who applied it Yes / No 1 pt
  5. Lockout locks are one color or style Yes / No 1 pt
  6. Lockout locks are not used for toolboxes, lockers or gates Yes / No 1 pt
  7. Each lock shows the name of its owner Yes / No 1 pt
  8. Tags read "Do not operate" with the worker's name and the date Yes / No 1 pt
  9. Tags are made of material that withstands moisture and grease Yes / No 1 pt
  10. Multi-lock hasps are available Yes / No 1 pt
  11. Breaker lockout devices fit the types of breakers in the site's panels Yes / No 1 pt
  12. Lockout devices for ball valves and gate valves are available Yes / No 1 pt
  13. Plug lockout devices are available for cord-and-plug equipment Yes / No 1 pt
  14. A group lock box is available for jobs with several workers Yes / No 1 pt
  15. The lockout station in the maintenance shop is stocked according to its content list Yes / No 1 pt
  16. 5 disconnect switches sampled accept a lock Yes / No 1 pt
  17. Blocks, pins or chains are available to hold dock levelers, lift tables and dampers in place Yes / No 1 pt
  18. Equipment seen locked out during the visit carried a lock and a tag for each worker on the job Yes / No 1 pt
  19. A tag alone is not used where a lock can be applied Yes / No 1 pt
  20. Lockout devices on site Rating
    • Personal locks and a device for every isolation point 5 pts
    • Personal locks, but no device for some breakers or valves 3 pts
    • Locks shared or not available 1 pt

3. Training 19 items

  1. Employees authorized to apply lockout Number
  2. Authorized employees with a current training record Number
  3. Date of the last lockout training session Date
  4. A written list names the employees authorized to apply lockout Yes / No 1 pt
  5. Each authorized employee has a training record Yes / No 1 pt
  6. Machine operators are trained to recognize a lockout and leave it alone Yes / No 1 pt
  7. Other employees working near the equipment have been told what locks and tags mean Yes / No 1 pt
  8. New technicians do not service equipment until they have been trained Yes / No 1 pt
  9. Training includes a hands-on demonstration on the site's equipment Yes / No 1 pt
  10. Retraining took place after the last change of equipment or procedure Yes / No 1 pt
  11. A technician asked described the lockout steps in the right order Yes / No 1 pt
  12. A technician asked named every energy source of a machine he or she services Yes / No 1 pt
  13. An operator asked said what to do on finding a lock on a machine Yes / No 1 pt
  14. Employees qualified for electrical work are named in writing Yes / No 1 pt
  15. Qualified employees are trained for the voltage levels they work on Yes / No 1 pt
  16. Qualified employees are trained on arc flash hazards Yes / No 1 pt
  17. A person trained in first aid and CPR is on site when electrical work is done Yes / No 1 pt
  18. Baler and compactor operators are trained before they are given the key Yes / No 1 pt
  19. Knowledge of lockout among the employees asked Rating
    • Described every step in order 5 pts
    • Missed a step or gave them out of order 3 pts
    • Could not describe the steps 1 pt

4. Electrical work 22 items

  1. Electrical jobs observed or reviewed with a technician during the visit Number
  2. Energized work permits issued in the last 12 months Number
  3. Electrical equipment is de-energized before work unless a written energized work permit is approved Yes / No 1 pt
  4. Only qualified electricians open panels or work inside them Yes / No 1 pt
  5. Panel covers and dead fronts removed for work are put back before the technician leaves the panel Yes / No 1 pt
  6. A barrier or an attendant keeps other people away from a panel that is open for work Yes / No 1 pt
  7. The technician stands to the side of a disconnect, not in front of it, when switching it Yes / No 1 pt
  8. Rings, watches and other conductive items are removed before work inside a panel Yes / No 1 pt
  9. Arc-rated clothing and a face shield of the rating named on the equipment labels are available on site Yes / No 1 pt
  10. A technician asked could read the required protective equipment from an arc flash label Yes / No 1 pt
  11. Voltage-rated gloves on site show no holes or cracks when rolled up to trap air Yes / No 1 pt
  12. Voltage-rated gloves are available with their leather protectors Yes / No 1 pt
  13. The test date on the voltage-rated gloves is within the interval set by company policy Yes / No 1 pt
  14. Insulated hand tools are used for electrical work Yes / No 1 pt
  15. The voltage tester is rated for the voltage of the site's systems Yes / No 1 pt
  16. Meters and test leads show no cracked casing or damaged insulation Yes / No 1 pt
  17. Capacitors in drives and uninterruptible power supplies are discharged before parts are touched Yes / No 1 pt
  18. Temporary jumpers and bypassed safety switches are removed when the repair is finished Yes / No 1 pt
  19. Cords or plugs found damaged are tagged out of service Yes / No 1 pt
  20. Panels fed from more than one source (generator, solar, uninterruptible power supply) are labeled as such Yes / No 1 pt
  21. Lamps and ballasts are replaced with the fixture de-energized Yes / No 1 pt
  22. Conditions for electrical work Rating
    • De-energized work, with tested gloves, rated meters and arc-rated clothing on site 5 pts
    • De-energized work, but gloves, meters or clothing missing or out of date 3 pts
    • Work on live parts without a permit, or by unqualified persons 1 pt

5. Verification 21 items

  1. Lockouts observed during the visit Number
  2. Lockouts observed with a step missed Number
  3. Date of the last periodic inspection of lockout procedures Date
  4. After the locks are applied, the worker tries the start control Yes / No 1 pt
  5. The control is returned to off after the try Yes / No 1 pt
  6. Absence of voltage is tested with a meter before electrical parts are touched Yes / No 1 pt
  7. The meter is tried on a known live source before the test Yes / No 1 pt
  8. The meter is tried on a known live source again after the test Yes / No 1 pt
  9. Pressure gauges are read at zero before work on air, hydraulic or steam lines Yes / No 1 pt
  10. Raised parts are blocked before anyone works under them Yes / No 1 pt
  11. A lockout observed during the visit followed the written procedure for that machine Yes / No 1 pt
  12. Tools are removed before the machine is re-energized Yes / No 1 pt
  13. Guards are replaced before the machine is re-energized Yes / No 1 pt
  14. People near the machine are told before it is restarted Yes / No 1 pt
  15. Each worker removes his or her own lock Yes / No 1 pt
  16. Each procedure is inspected, on the schedule set by the lockout program, by an authorized employee who does not use it Yes / No 1 pt
  17. The periodic inspection includes a review with each authorized employee Yes / No 1 pt
  18. Deficiencies found by the last periodic inspection have been corrected Yes / No 1 pt
  19. Supervisors make unannounced observations of lockout in progress Yes / No 1 pt
  20. Troubleshooting that needs the machine energized follows a written sequence Yes / No 1 pt
  21. Verification of isolation in practice Rating
    • Tried and tested every time 5 pts
    • Locks applied but verification sometimes skipped 3 pts
    • Verification not practiced 1 pt

6. Records 19 items

  1. Periodic inspection records show the machine, the date, the employees included and the inspector Yes / No 1 pt
  2. Training records show the names and dates for authorized and affected employees Yes / No 1 pt
  3. A log shows which locks are assigned to which employee Yes / No 1 pt
  4. Approved energized work permits are on file Yes / No 1 pt
  5. Each removal of a lock by a manager is documented on a form Yes / No 1 pt
  6. Incidents and near misses involving unexpected start-up or electric shock have been investigated Yes / No 1 pt
  7. Each energized work permit on file states why the equipment could not be shut off Yes / No 1 pt
  8. Date of the arc flash study Date
  9. Each energized work permit on file is signed by a manager other than the person who did the work Yes / No 1 pt
  10. The arc flash study is dated within the interval set by company policy Yes / No 1 pt
  11. Test records for voltage-rated gloves are on file Yes / No 1 pt
  12. The list of machines with procedures matches the equipment list in the maintenance system Yes / No 1 pt
  13. The lockout program was reviewed in the last 12 months Yes / No 1 pt
  14. Findings of the previous lockout audit have been closed Yes / No 1 pt
  15. Lockout or electrical incidents in the last 12 months Number
  16. Name of the person who owns the lockout program Short text
  17. Name of the facility manager Short text
  18. Overall lockout and electrical safety Rating
    • Procedures, devices and training in place and followed in practice 5 pts
    • Program in place with gaps in procedures, training or records 3 pts
    • Equipment serviced without isolation or by unqualified persons 1 pt
  19. Corrective actions required Comments

About this template

This checklist is part of the InspectLoop template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In InspectLoop you can add photos, assign corrective actions, require sign-off and compare results across sites.

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