Lockout Tagout Verification

Lockout Tagout Verification — Form Fields

This operations template includes 7 fields. Verify and document that lockout/tagout (LOTO) procedures have been correctly applied before maintenance work begins. Captures equipment, energy sources isolated, and technician confirmation for regulatory compliance. Protects workers from unexpected energization of machinery during service. Free to customize and use on ZenBuild.

• Authorized Employee / Technician (text, required)
• Equipment / Machine Being Serviced (text, required)
• Date and Time of LOTO Application (text, required)
• Energy Sources Isolated (checkboxes, required) — options: Electrical, Hydraulic, Pneumatic / Compressed Air, Thermal / Steam, Gravity / Mechanical
• Zero Energy State Verified? (multiple choice, required) — options: Yes – tested and confirmed, No – verification incomplete
• Supervisor Notified? (multiple choice, optional) — options: Yes, No
• Notes / Additional Energy Sources (long text, optional)