3 appendix I
Example Checklist: Quick Checklist for Lockout/Tagout
A. STEPS FOR SHUTDOWN:
1 Prepare — Before you begin, be sure you know:
a all the types of energy involved.
b hazards presented by energy.
c how to control the energy.
2 Shutdown — Turn off the machine or equipment.
3 Isolate — Isolate the machine or equipment from the energy source (i.e., turn off the
main circuit breaker).
4 Lockout — Apply your lock. Be sure that it holds the isolating device in the “off” or
“safe” position.
5 Release — Release stored energy. Relieve, disconnect, restrain, block, or otherwise
ensure that all energy sources (such as electrical, mechanical, hydraulic, compressed,
or others) are de-energized.
6 Verify — Try the on-off switch or other controls to be sure the machine will not start.
Return the switch to the “off” position.