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Lockout/Tagout (LOTO) Procedure Template

A machine-specific energy control procedure in Word. It lists every energy source with its isolation point and how to verify it is at zero, then gives the shutdown, lockout, verification and release steps in order, with sections for group lockout, shift changes and the annual periodic inspection record.

Who this template is for

When to use it

Standards it supports

How to use this template

  1. Walk down the machine — trace and tag every energy source: electrical, hydraulic, pneumatic, gravity, springs, thermal and chemical.
  2. Fill the energy source table — record the type, magnitude, isolation device, its location, the lockout method and how you will verify zero energy.
  3. Write the sequence — write the shutdown, isolation, lock application, stored energy and verification steps in the order they are done.
  4. Write the release — say how to check the area, account for people, remove locks and restart, and who may remove a lock.
  5. Test, approve and inspect — walk the procedure on the machine with an authorized employee, approve it, post it, and inspect its use at least once a year.

Tip: Put a photo of each isolation point next to its row in the energy source table, and label the device on the machine with the same ID. People find the right valve faster from a picture than from a description.

What's inside the template

1

Equipment and scope

Machine ID, location, the servicing tasks covered, and any tasks that need a different procedure

2

People

Authorized employees, affected employees, and who to notify before and after lockout

3

Energy sources

Each source with its ID, type, magnitude, isolation device and location, lockout method and verification

4

Lockout sequence

Prepare, notify, shut down, isolate, apply locks and tags, release stored energy, verify zero energy

5

Release from lockout

Inspect the area, account for people, notify, remove locks, restart

6

Group lockout, shift change and inspection

Lockbox method, handover between shifts, and the annual periodic inspection record

Example: a completed template

Example Energy control procedure for hydraulic press HP-01 at Example Fabrication Co., a fictional metal fabricator. The machine, energy sources, values and crew are invented for illustration; write yours from a walk-down of your own machine and its manufacturer’s manual.

Equipment and scope

MachineHP-01 hydraulic press, press bay
Tasks coveredDie change, ram guide adjustment, hydraulic hose replacement
Authorized employeesMaintenance Techs trained on this procedure
Affected employeesPress operators and setup lead in the press bay

Energy sources

IDEnergyIsolation pointMethodVerify zero
E-1Electrical, 480 VAC mainDisconnect DS-HP01 on the east wallSwitch OFF, lock and tagPress start; qualified person tests for absence of voltage
E-2Electrical, 120 VAC oil heaterBreaker 14, panel LP-2Breaker OFF, breaker lockout, tagHeater indicator off; test for absence of voltage
H-1Hydraulic, stored pressure in accumulatorDump valve HV-3Open valve, lock open with valve cover, tagGauge PG-1 reads 0
G-1Gravity, ram weightRam lowered onto the die safety blocksInsert both blocks before lowering the ram onto themTry to jog: no movement

Lockout sequence (summary)

Group lockout for a three-person die change

Lockable points3 (E-1, E-2, H-1); G-1 is blocked, not locked
MethodLead tech applies one department lock at each point and puts the keys in the group lockbox
Personal locksEach of the 3 techs locks the lockbox and removes only their own lock

The math in this Example

How to fill in each field

FieldWhat to enterExample
Machine and scopeOne machine, or a set of identical machines, per procedure. List the servicing tasks it covers so people know when it applies.HP-01; die change, ram guide adjustment, hose replacement
Authorized / affected employeesAuthorized employees apply locks and do the work. Affected employees operate or work near the machine and must be told before and after.Authorized: trained Maintenance Techs
Energy source IDA short ID that matches a label on the machine at the isolation point.H-1
Type and magnitudeThe kind of energy and how much, so people judge the hazard and choose the right test equipment.Electrical, 480 VAC
Isolation device and locationThe device that physically blocks the energy, such as a disconnect, breaker or valve, and exactly where to find it. A stop button or control circuit is not an isolation device.Disconnect DS-HP01, east wall
Lockout methodHow the device is put in the safe position and locked, including any lockout hardware needed.Breaker OFF, breaker lockout, tag
Stored energyHow to release, block or restrain energy that stays after isolation: pressure, springs, raised parts, capacitors, heat.Open dump valve; lower ram onto safety blocks
VerificationHow you prove each source is at zero before work starts, such as trying the start control, reading a gauge or testing for voltage.Gauge PG-1 reads 0
Release stepsRemove tools, reinstall guards, account for every person, notify affected employees, remove locks, then restart.Headcount against the lockbox before removing locks
Periodic inspectionAt least once a year an authorized employee who does not use this procedure checks it is followed, and the inspection is recorded.2026-03-10, Maintenance Supervisor, no deviations

Common mistakes

Frequently asked questions

Is lockout/tagout required by OSHA?

In US general industry, servicing and maintenance where unexpected start-up or release of stored energy could cause injury is covered by OSHA’s control of hazardous energy standard, 29 CFR 1910.147. Electrical work has further requirements in 1910.333. Other countries have their own rules, so check the ones that apply to your site.

Do I need a written procedure for every machine?

Generally yes. The standard allows an exception only when a machine meets every one of a short list of conditions, such as having a single energy source that is easy to isolate and lock. Most production machines do not meet all of them.

What is the difference between lockout and tagout?

Lockout puts a lock on the isolating device so it cannot be operated. Tagout attaches a warning tag but does not physically stop anyone. The OSHA standard expects lockout when the device can be locked, and allows tagout alone only when a tagout program gives protection equal to lockout.

Who can remove a lock?

The person who applied it. The standard allows an exception only when that person is not at the facility, under a documented procedure that includes verifying they have left, making all reasonable efforts to reach them, and telling them before they return to work.

How often must LOTO procedures be inspected?

At least once a year for each energy control procedure, by an authorized employee who is not using it, with a certification that records the machine, the date, the people involved and who did the inspection.

Can I use this template as is?

Use it as a structure. Every energy source, isolation point and verification step must come from a walk-down of your machine and its manual, and be reviewed by someone competent in your site’s energy control program.

See also

COPLAIN AI PLATFORM

Generate yours automatically from your existing docs

Once the procedure is approved, upload it and Coplain turns it into a visual job aid that shows each isolation point in order, with the warnings at the step where they apply, ready for your safety review.

Generate yours automatically with Coplain →

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