Lockout/Tagout Audit Record
Date of Audit
Auditor Name
Location/Area
Authorized Employee(s)
Equipment/Process
Audit Item
Yes
No
Remarks
Loto procedure is available and correct
All hazardous energy sources identified
Lockout devices used properly
Tagout devices attached and legible
Employees demonstrate proper procedure
Equipment verified de-energized before work
Corrective Actions Required
Follow-up Required
Yes
No
Date Completed