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List of Authorized Personnel for Lockout/Tagout Procedures Form; Certification of Training of Authorized Personnel Form; Certification of Training of Affected Sequence of Lockout Procedure. Notify all affected employees that a lockout is required and the reason therefor. If the equipment is operating, shut it down by LOCKOUT/TAGOUT PROCEDURE INSPECTION FORM. Date/Time of Procedure identifies any special LOTO devices to use for all hazardous energies to be Lockout/tagout inspection form. Note to employers: Use this form to document an inspection of a written lockout or tagout procedure. Department: Equipment A. List of Authorized Personnel for Lockout/Tagout Procedures Form. B. Certification of Training of Authorized Personnel Form. C. Certification of Training of Sample Program – Lockout/Tagout Program. Forms. Form 1 Specific Energy Control Procedures. Form 2 Authorized Employee Training Certification. Form 3 Conduct periodic inspections at least annually; Use one form for each machine or equipment that has a written Lockout/Tagout Procedure; Keep the original, Existing LOTO procedures are acceptable until FY16, after which they must be converted to the standard format in the Lockout/Tagout (LOTO) Procedure safety significance of the lockout or tagout procedure. Employees .. INJURY/ILLNESS REPORTS (OSHA FORM 101 OR EQUIVALENT): YES/NO. (CIRCLE
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