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Lockout Tagout Form

This lockout/tagout form is used to document the lockout of equipment during maintenance to ensure safety. It records the location, equipment isolated, lock/tag number, responsible individuals installing and removing locks, and signatures verifying the completion of maintenance and lock removal.

Uploaded by

Srinivas Murthy
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© © All Rights Reserved
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181 views

Lockout Tagout Form

This lockout/tagout form is used to document the lockout of equipment during maintenance to ensure safety. It records the location, equipment isolated, lock/tag number, responsible individuals installing and removing locks, and signatures verifying the completion of maintenance and lock removal.

Uploaded by

Srinivas Murthy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Lockout / Tag out Form

Format No.:

Location / Area Date

Lock /tag Number Equipment Name Equipment Isolated

Procedure No. Lock box Number Responsibility Given

Initials – Individual Lock installed Lock removed


Energy Isolation
Operation Lock No. name & Date name & Date

Equipment verified by:


Maintenance Engineer: Signature & date
Operations:

Maintenance Completed by: Signature & Date


Manager – maintenance Signature:

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