Summary Statement

Checklist provided by the California State Compensation Insurance Fund to help contractors make sure they have taken the necessary steps to disengage, de-energize and block or lock-out equipment before the equipment is cleaned, serviced, adjusted, etc. Part of a collection. Click on the 'collection' button to access the other items.

HAZARD satisfactory Needs
Target Date of
Is all equipment capable of movement, required to be disengaged, de-energized and blocked or locked-out during cleaning, servicing, adjusting or setting up operations, whenever possible?        
Where the power disconnecting means for equipment does not also disconnect the electrical control circuit:        

Are the appropriate electrical enclosures identified?


Are means provided to assure the control circuit can also be disconnected and locked out?

Is the locking-out of control circuits in lieu of locking-out main power disconnects prohibited?        
Are all equipment control valve handles provided with a means for locking-out?        
Does the lock out procedure require that stored energy (mechanical, hydraulic, air, etc.) be released or blocked before equipment is locked-out for repairs?        
Are appropriate employees provided with individually keyed personal safety locks?        
Are employees required to keep personal control of their key(s) while they have safety locks in use?        
Is it required that only the employee exposed to the hazard, place or remove the safety lock?        
Is it required that employees check the safety of the lock out by attempting a start up after making sure no one is exposed?        
Are employees instructed to always push the control circuit stop button prior to re-energizing the main power switch?        
Is there a means provided to identify any or all employees who are working on locked-out equipment by their locks or accompanying tags?        
Are a sufficient number of accident preventive signs or tags and safety padlocks provided for any reasonably foreseeable repair emergency?        
If an operation requires the operator to leave his station to do other functions, & part of the machine could move if accidentally activated, is such element required to be locked or blocked out?        
In the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job procedure established and rigidly followed?        
Name Date