LOTO / Energy Isolation Verification

Prove isolation before work with our LOTO / Energy Isolation Verification. Designed for maintainers and supervisors, this template covers preparation, isolation and try-out, and restoration.

Assumed isolation kills. This certificate records points isolated, try-out, and who holds the locks.

What is included

Preparation:

• Machine, task, and authorised persons

Isolation & Verification:

• Isolation points and lock numbers
• Try-out / prove zero

Restoration:

• Locks removed, energy restored, area clear
• Sign-off

Using this template allows you to:

• Standardise LOTO verification
• Record isolation points and try-out
• Control restoration after the job

Disclaimer: This template is provided as a guidance tool only. All inspections and follow-up actions must be carried out in line with your organisation’s procedures and local health and safety regulations. We do not accept responsibility for how this checklist is used.

Download the LOTO / Energy Isolation Verification today to prove energy isolation before anyone works.