Template guide
Lockout tagout procedure template for machine-specific documentation
A lockout tagout procedure template organizes equipment information for review. It cannot determine how a particular machine must be isolated. Use this worksheet with your organization’s energy control program and the people authorized and qualified to develop and verify the procedure.
Gather the equipment information first
Identify the exact machine, its location and the work the procedure covers. Confirm the information against the equipment and its documentation. Similar machines can have different energy sources or isolation arrangements; do not assume a procedure from one machine applies to another.
- Equipment identity: asset name, identifier, location and scope of work.
- Energy sources: each relevant source, including stored energy, as identified through the site’s assessment.
- Isolation points: device identification, location and clear reference photos.
- Machine-specific instructions: approved shutdown, isolation, lockout, stored-energy control and return-to-service information.
- Verification: the approved method for confirming control of each energy source.
- Review information: responsible person, revision date and approval record under your program.
Blank documentation worksheet
Equipment / asset ID: [identifier]
Location: [location]
Work covered: [scope]
Energy source: [source identified by assessment]
Isolation device and location: [verified details]
Reference photo: [photo label]
Approved control instructions: [machine-specific instructions]
Approved verification method: [method]
Reviewed by / revision: [record]
Repeat the energy-source fields for every source identified during the assessment. Do not use a generic “power off” entry in place of the actual isolation and verification information.
How the builder helps
The builder organizes the machine details, energy-source entries and photos into a procedure preview and a compact equipment placard. Review both documents together: a short placard should point people to the same equipment and isolation points described in the full procedure.
Before releasing the documents, have the responsible personnel verify the content at the equipment, resolve omissions and apply your organization’s approval process. A generated document alone does not establish a safe procedure or regulatory compliance.
Use the applicable energy control requirements
For U.S. workplaces, OSHA’s hazardous energy standard, 29 CFR 1910.147, addresses energy control procedures, training and periodic inspections. In Canada, CCOHS’s lockout/tagout guidance provides an overview; confirm the requirements that apply to your jurisdiction and equipment. This worksheet supports documentation and does not replace those requirements, training or site-specific review.
Free outline and Pro document formats
Prepare and preview the equipment documentation free in your browser. Pro adds clean procedure and photo placard PDFs. Qualified site review is still required. The Pro upgrade is $49 USD, paid once. You can copy the planning outline on this page into your own notes.
Open Lockout/Tagout Procedure Builder and review the preview →