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Lockout Tagout Safety Program (Version 1)

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Lockout/tagout violations occur when machines or equipment are not properly shut down before maintenance or repair.  This can lead to serious injuries or fatalities if the machine or equipment is accidentally turned on.  Employers are required to create a Lockout Tagout Safety Program so employees know how to avoid the risk of unintentional machine startups.


Paper Jester Safety Resources has created an easily customizable digital Lockout Tagout Safety program template with recommended areas of revision highlighted in yellow for immediate identification.


Topic outline includes:

  • Purpose
  • Scope
  • General Provisions
  • Lockout Procedure Sequence
  • Hazardous Energy Control Procedures
  • Training
  • Annual Inspection
  • Recordkeeping
  • LOTO Acknowledgement Form - Sample
  • LOTO Demonstration Form - Sample
  • LOTO Audit Form


Pages: 10

Language: English

Federal OSHA Control of Hazardous Energy (Lockout) Standard (General Industry)

(verify that your state doesn't have it's own plan before referencing federal standards)

  • Microsoft Word 97-2003 Document (.doc)

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