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Lockout/Tagout (LOTO) Procedure Template

This template is designed to document the isolation of hazardous energy sources during maintenance.
Veolia
07/04/2024

Lockout/Tagout (LOTO) Procedure Template

This template is designed to document the isolation of hazardous energy sources during maintenance.

    Involved Personnel

    Authorized Personnel 1

    Authorized Personnel 2

    Affected Personnel 1

    Affected Personnel 2

    Hazardous Energy (Energy Type - Measure - Source)

    Energy Isolation Devices (Type - Location / ID - Zero Energy Check)

    Procedure

    Preparers Name

    Prepared Date

    Reviewers Name

    Reviewed Date

    Reference Document:

    Source: Veolia (Community Member)

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