What's Included in the Template
This lockout tagout procedure template includes every field required by OSHA 1910.147(c)(4) for a compliant energy control procedure:
- Equipment identification: name, location, and purpose
- Energy source inventory: type, magnitude, and location for each source
- Isolation point details: device location, isolation method, and required hardware
- Shutdown sequence: ordered steps for safe deenergization
- Verification steps: how to confirm zero energy state
- Reenergization sequence: ordered steps for safe restart
- Authorized and affected employee roles
Printable LOTO Procedure Template
Fill in one copy for each piece of equipment. The button below prints the template on its own; choose "Save as PDF" in the print dialog to keep a digital copy.
Energy Control Procedure (Lockout/Tagout)
| Equipment name | Procedure no. | ||
|---|---|---|---|
| Equipment ID | Revision / date | ||
| Location | Prepared by | ||
| Department | Approved by |
1. Purpose and scope
The intended use of this procedure: the equipment it covers and the servicing or maintenance it applies to.
2. Hazardous energy sources
| Energy type | Magnitude | Isolating device and location | Lock / tag | Verification method |
|---|---|---|---|---|
3. Shutdown and isolation
- Notify affected employees that the equipment is being shut down and locked out.
- Shut down the equipment using its normal stopping procedure.
- Operate each energy-isolating device listed above.
- Apply a lock and tag to each energy-isolating device.
- Relieve, disconnect, or restrain stored and residual energy.
- Verify isolation: confirm no one is exposed, attempt a normal start-up, test for zero energy, then return the controls to off.
Steps specific to this equipment:
4. Placing, removing, and transferring locks and tags
Who applies and removes each device, and how responsibility transfers at a shift or personnel change.
5. Return to service
- Remove tools and nonessential items from the work area and confirm the equipment is intact.
- Confirm all employees are safely positioned or clear of the equipment.
- Notify affected employees before locks and tags are removed.
- Each authorized employee removes their own lock and tag.
6. Employees
| Authorized employees | |
|---|---|
| Affected employees |
Periodic inspection (at least annually)
| Date | Inspected by | Employees included | Notes |
|---|---|---|---|
How to Use This Template
- Print the template above, or save it as a PDF from the print dialog, and make a copy for each piece of equipment
- Walk the shop floor with maintenance personnel to identify all energy sources
- Document each isolation point with specific locations and methods
- Define the shutdown and reenergization sequences in order
- Have an authorized employee review the completed procedure
- Train all affected employees on the new procedure
Limitations of Paper Templates
Paper templates work for small programs with a few procedures. For a detailed comparison, see Digital vs Paper LOTO Procedures. As your program grows, you'll run into version control issues, inconsistent formatting, and difficulty tracking inspections across dozens or hundreds of procedures.
LOTOBuilder replaces paper templates with a digital procedure builder that generates professional, OSHA-compliant PDFs in minutes. See all features or start your free trial.