Isolation and Lockout/Tagout (LOTO) Verification Sheet
Site / Location:
Equipment / Asset:
Work Description:
Permit Number:
Date:
Authorized Person(s):
Person Performing Verification:
Step / Description
Isolation Point
Type of Energy
Isolation Device(s)
Lock/Tag Number
Verification Method
Verified By
Date / Time
Comments
Additional Comments:
Signature (Person Performing Verification):
Date/Time: