🔒

Lockout/Tagout Isolation Verification

A quick LOTO record for isolating equipment, verifying zero energy, and handing back safely.

Lockout/Tagout Isolation Verification
You’ll be asked to sign in first.
manufacturingfacilitiesutilitiessafetymaintenance
Use when you need a consistent, repeatable record of isolation points and verification steps.

Form preview

Job
Site*
Text
[not set]
Area/Line
Text
[not set]
Work Order ID
Text
[not set]
Equipment/Asset*
Text
[not set]
Asset ID
Text
[not set]
Date*
Date
📅 Select date
Start Time
Time
⏰ Select time
End Time
Time
⏰ Select time
Isolation
Energy Sources
List
List each energy source that must be isolated.
TypeIsolation LocationIsolation Method
+ Add+ Add+ Add
Locks/Tags Applied
List
PersonLock IDPoint
+ Add+ Add+ Add
Stored Energy Released*
Toggle
[not set]
Verification Method*
Text Area
How did you verify zero energy? (try-start, meter test, bleed-down, etc.)
How did you verify zero energy? (try-start, meter test, bleed-down, etc.)
Verification Result*
Text
VerifiedNot verified
Verified
Not verified
Photo
Photo
No photos captured
Notes
Text Area
Sign-off
Isolated By*
Text
[not set]
Verified By*
Text
[not set]
Handback / Restore Power
Text Area
What was checked before restoring power?
What was checked before restoring power?
Restored By
Text
[not set]
EXAMPLE REPORTSample data — shows what you’ll get after recording

Example filled report

Job
Site
Plant A
Area/Line
Packaging Line 2
Work Order ID
WO-18427
Equipment/Asset
Case sealer conveyor
Asset ID
CONV-CASE-02
Date
02/11/2026
Start Time
9:10 PM
End Time
9:28 PM
Isolation
Energy Sources
TypeIsolation LocationIsolation Method
ElectricalPanel P2 - disconnect switchDisconnect + lock
PneumaticAir supply quick-connect at machineValve closed + line bled
Locks/Tags Applied
PersonLock IDPoint
Sam T.L-0192P2 disconnect
Sam T.L-0192Air valve
Stored Energy Released
Yes
Verification Method
Try-start confirmed no motion; verified 0V at motor leads with meter; bled residual air pressure to zero.
Verification Result
Verified
Photo
No photos captured
Notes
Guard removed after isolation; kept hardware in tray; restarted after confirming all tools cleared.
Sign-off
Isolated By
Sam T.
Verified By
Alex R. (Supervisor)
Handback / Restore Power
Checked guards reinstalled, area clear, all locks removed by owners, disconnect restored, air connected, test run OK.
Restored By
Sam T.
Lockout/Tagout Isolation Verification | Voiz Report Templates