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Topic: MODEL INSPECTION FORM

Documentation of Periodic Energy Control Procedure Inspection

Here's a Model Form you can use to document that you've conducted periodic inspections of energy control procedures as required by the OSHA lockout/tagout standard. Speak to your attorney about adapting it for your own use.

ENERGY CONTROL PROCEDURES:

OSHA SELF-INSPECTION CERTIFICATION

1.  Date of Inspection: __________________________________________________

2.  Area or Department: __________________________________________________

3.  Equipment Covered By Procedure(s) Inspected:

Name of Equipment: __________________________________________________

Serial/ID Number: __________________________________________________

4.  Type of Procedure Inspected:

Lockout


Tagout

5. Employees Spoken To:

Name & Dept: Further Training Req'd:
_________________________________________ Yes    No
_________________________________________ Yes    No
_________________________________________ Yes    No
_________________________________________ Yes    No
_________________________________________ Yes    No
_________________________________________ Yes    No
_________________________________________ Yes    No

6. Inspector's Name, Ext.: _________________________________________________


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Comments Story Comments (%)

    I'd also respectfully suggest a line for: "No change in equipment or area" as part of #3.

    I.E. We not only wish to know the personnel are 'current' but also the actual procedures. I also look, if in a plant where a copy of the procedures are posted/affixed at the machine, that the copy is current & legible (some become stained, torn, lost). I mention 'area' because of the enviroent has changed (something now crowded up to the machine or new proximity of combustibles, etc) may mean a change in needed in the procedure.

    Good article as a lot of people charged with EH&S duties have little formal training &/or experience so need resources like this; i.e. EH&S 101!

    Gerald

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