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Free LOTO / isolation checklist

Free LOTO / isolation checklist (PDF-ready). Covers lock points, energy sources, tags, verification and re-energisation procedure. Download free.

Updated 2 Oct 2026

LOTO / Isolation Checklist

Complete before commencing any maintenance, repair or inspection on isolated equipment

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0 of 14 checks

Checklist

1All energy sources identified
2Affected personnel notified
3Equipment shut down in normal sequence
4All isolation points locked and tagged
5Stored/residual energy dissipated or blocked
6Zero energy verification completed (try test)
7Isolation register updated
8LOTO signage in place
9All tools and materials removed from equipment
10All guards and covers replaced
11All personnel clear of equipment
12Locks and tags removed by authorised person only
13Affected personnel notified of re-energisation
14Equipment restarted and tested

Isolation Officer Sign-off

Signature

Print name

Date & time

Supervisor Sign-off

Signature

Print name

Date

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Jarrod Milford

Jarrod Milford

Co-Founder & Commercial Director

Updated 2 October 2026
Also see:Compliance and inspections →Best inspection software →MapTrack vs SafetyCulture →

Short answer

A LOTO isolation checklist records each isolation: the equipment and reason, every energy source and its isolation point, lock and tag numbers, each worker's personal lock, the zero-energy test and the de-isolation sign-off. Complete one every time plant is isolated for maintenance, repair, cleaning or clearing a jam. Regulation 210 of the model WHS Regulations requires operator controls able to be locked off to disconnect all motive power.

Checked against Model WHS Regulations as at 5 December 2025 (cited within as the Work Health and Safety Regulations 2011) on by the MapTrack templates team. How we check templates

Key takeaways

  • The MapTrack LOTO / isolation checklist contains 14 checks.
  • Section 4.5 of the model plant Code names lock-out as the most effective isolation procedure before maintenance, repair or cleaning.
  • Reg 156 requires de-energised electrical equipment to be kept from being inadvertently re-energised while electrical work is done.
  • Each worker fits their own personal lock, using a multi-lock hasp or a lockbox for group isolations. A tag on its own does not isolate.
  • After isolating and locking, release or restrain stored energy such as hydraulic pressure, springs and raised loads, then verify zero energy before work starts.
  • In the US, 29 CFR 1910.147(c)(6) requires each energy control procedure to be inspected at least annually, with the inspection recorded.

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What is a LOTO / isolation checklist?

A lockout/tagout (LOTO) isolation checklist is a systematic form used to ensure that all hazardous energy sources on a piece of equipment or plant are identified, isolated, locked, tagged and verified as zero energy before any maintenance, repair, cleaning or inspection work begins. It is a critical safety control under Australian WHS legislation, designed to prevent the uncontrolled release of stored energy, which can result in electrocution, crushing, burns, amputations and fatalities. The checklist also documents the re-energisation procedure to ensure equipment is safely returned to service when the work is complete.

Failure to properly isolate equipment can cause serious injuries and fatalities. The LOTO isolation checklist provides a step-by-step verification process that ensures no energy source is overlooked, every worker applies their own personal lock, and zero energy is confirmed before hands-on work begins. The completed checklist creates a defensible audit trail that shows each isolation followed your procedure and the WHS Regulations. AS/NZS 4024.1603:2019 (Safety of machinery, Prevention of unexpected start-up) covers the isolation and locking devices designed into machinery, and the WHS Regulations 2011 shape the minimum requirements for isolation procedures: plant controls must be able to be locked in the off position to disconnect all motive power (regulation 210), and electrical work must not be carried out on energised equipment except where the regulations allow, with de-energised equipment kept from being inadvertently re-energised (regulations 154 to 157, Part 4.7). A completed LOTO checklist with lock and tag serial numbers, isolation point identification and personal verification signatures provides the documented proof regulators and insurers expect during audits and incident investigations.

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Benefits of using this LOTO / isolation checklist

  • Worker safety: prevents the uncontrolled release of hazardous energy during maintenance, protecting workers from serious injury or death.
  • Regulatory compliance: meets WHS isolation requirements and demonstrates due diligence to regulators and auditors.
  • Complete energy identification: the structured energy source table ensures no energy type is overlooked, reducing the risk of residual energy incidents.
  • Clear accountability: documents who applied each lock and tag, who verified zero energy and who authorised re-energisation.
  • Audit trail: signed checklists create a defensible record for safety audits, investigations and insurance claims.
  • Safe re-energisation: the re-energisation checklist ensures equipment is returned to service only after all personnel are clear and guards are replaced.

Benefits of digitising forms in MapTrack

When you move your checklists from paper to MapTrack, you get:

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  • Build conditional logic (show or hide questions based on answers).
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  • Keep every hazard and incident report against the site it came from, with photos.
  • Turn a hazard report into a corrective-action work order with its own review step.

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What to include in a LOTO / isolation checklist

This LOTO / isolation checklist covers 8 key areas:

  • Isolation details: permit/reference number, date, site/location, equipment/plant being isolated and reason for isolation.
  • Personnel: isolation officer and authorised person.
  • Energy source identification table: energy type (electrical, hydraulic, pneumatic, mechanical, thermal, chemical, gravity, stored energy), isolation point, isolation method, lock number and tag number.
  • Pre-isolation checklist (P/F/N/A): all energy sources identified, affected personnel notified, equipment shut down in normal sequence, all isolation points locked and tagged, stored/residual energy dissipated or blocked, zero energy verification completed (try test), isolation register updated, LOTO signage in place.
  • Overall result: pass, fail or action required.
  • Isolation verification: verified by, date and time.
  • Re-energisation checklist: all tools and materials removed, guards and covers replaced, all personnel clear, locks and tags removed by authorised person only, affected personnel notified, equipment restarted and tested.
  • Sign-off: isolation officer and supervisor signatures.

How to use this LOTO / isolation checklist

  1. Fill in the isolation details - permit number, date, site, equipment being isolated and the reason for isolation.: Assign a unique permit or reference number for traceability. Record the equipment name, asset ID, location and the specific reason for isolation (maintenance, repair, cleaning, inspection). This information identifies the scope of the isolation event.
  2. Record the isolation officer and authorised person names.: The isolation officer is the competent person who performs the physical isolation. The authorised person approves the isolation and ensures the procedure is followed. Record both names with their roles and contact details.
  3. Identify all energy sources associated with the equipment using the energy source table - document each energy type, isolation point, method, lock number and tag number.: Review the equipment isolation diagram or register. List every energy source: electrical, hydraulic, pneumatic, mechanical, thermal, chemical, gravitational and stored energy. For each source, record the specific isolation point, the method of isolation and the lock and tag numbers applied.
  4. Notify all affected personnel that the equipment is being isolated.: Inform all workers, operators and contractors who may be affected by the equipment being taken out of service. Use a verbal briefing, written notice or toolbox talk and obtain acknowledgement that they understand the isolation is in effect.
  5. Shut down the equipment following the normal shutdown sequence.: Follow the manufacturer or site procedure for normal shutdown. Do not simply switch off at the isolator as this may leave stored energy in the system. Allow the equipment to come to a complete stop before proceeding to isolation.
  6. Apply locks and tags to all isolation points. Each person working on the equipment should apply their own lock.: Use a personal danger lock and tag for each isolation point. Each worker applies their own lock so that the equipment cannot be re-energised until every worker has removed their lock. Use a multi-lock hasp where more than one person needs to lock the same point.
  7. Dissipate or block any stored or residual energy (e.g. bleed hydraulic lines, discharge capacitors, block raised loads).: After isolation, stored energy may remain in the system. Bleed hydraulic and pneumatic lines to zero pressure. Discharge capacitors. Block or pin raised loads, spring-loaded mechanisms or counterweights. Verify that all stored energy has been safely dissipated or restrained.
  8. Perform zero energy verification - attempt to start the equipment (try test) to confirm isolation is effective.: Press the start button or operate the controls to verify the equipment does not start. This try test confirms that all energy sources have been effectively isolated. Return controls to the off position after the try test. If the equipment starts, stop immediately and re-check all isolation points.
  9. Complete the pre-isolation checklist, marking each item as Pass, Fail or N/A.: Work through each checklist item systematically: all energy sources identified, affected personnel notified, equipment shut down, all points locked and tagged, stored energy dissipated, zero energy verified, isolation register updated and signage in place. Mark each as Pass, Fail or N/A.
  10. When work is complete, follow the re-energisation checklist before removing locks and returning equipment to service.: Confirm all tools and materials have been removed, guards and covers are replaced, all personnel are clear of the equipment and accounted for. Each worker removes their own lock only. Notify affected personnel that the equipment is being re-energised. Start the equipment and verify normal operation.

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How often should you complete this checklist?

A LOTO isolation checklist must be completed every time equipment or plant is isolated for maintenance, repair, cleaning, inspection or any other work that could expose workers to hazardous energy. This includes planned maintenance, breakdown repairs, cleaning inside machinery, changing tooling or dies, and clearing jams or blockages. A new checklist is required for each isolation event - even if the same equipment was isolated previously. If additional workers need to work on the equipment, each person must apply their own lock using a group isolation or multi-lock hasp arrangement. Check your organisation's isolation management procedure and your state or territory WHS regulations for specific requirements.

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Frequently asked questions

A LOTO (lockout/tagout) isolation checklist is a structured form used to ensure that equipment or plant is properly de-energised, locked out and tagged before maintenance, repair or inspection work begins. It documents every energy source (electrical, hydraulic, pneumatic, mechanical, thermal, chemical, gravity and stored energy), the isolation points, lock and tag numbers, and the results of zero-energy verification testing. In Australia, isolation procedures are a requirement under WHS regulations, and a well-completed LOTO checklist demonstrates that the correct process has been followed to protect workers from the uncontrolled release of hazardous energy.

All forms of hazardous energy associated with the equipment must be identified and isolated. This includes electrical (mains power, batteries, capacitors), hydraulic (pressurised fluid lines, rams, accumulators), pneumatic (compressed air, gas lines), mechanical (moving parts, springs, flywheels, conveyor belts), thermal (steam, heated surfaces, ovens), chemical (process chemicals, pipelines), gravity (raised loads, counterweights, suspended platforms) and stored or residual energy (capacitors, pressurised vessels, spring-loaded mechanisms). Each energy source must have a documented isolation point and method.

AS/NZS 4024.1603:2019 (Safety of machinery, Prevention of unexpected start-up) is a machine design standard. It covers the means designed into machinery to isolate it from its power supplies, lock those isolators, dissipate or restrain stored energy and verify the isolation. Personal locks, danger tags, try-out, group lockout and training belong in your own isolation procedure. The standard complements the WHS Regulations requirement for the PCBU to manage risks associated with plant.

Yes. Download and use this LOTO isolation checklist for free. It downloads as a ready-to-print PDF. No MapTrack account is required. If you want digital isolation permits with electronic lock registers, QR code scanning at isolation points and automated audit trails, MapTrack can help. Book a demo to see how.

The LOTO isolation checklist itself should be reviewed at least annually as part of the organisation's safety management system review. Beyond that scheduled review, an immediate update is required after any incident or near miss involving an isolation failure, when new plant or energy sources are introduced, or when changes to legislation or standards affect isolation requirements. The WHS Regulations also require control measures to be reviewed and, as necessary, revised, for example when a control fails or before a change at the workplace (regulation 38). Keeping checklists current ensures they reflect the actual equipment and energy sources present on site.

Fill in the isolation details first: permit or reference number, date, site and the equipment being isolated, then the names of the isolation officer and the authorised person. Identify every energy source associated with the equipment using the energy source table, notify all affected personnel, and shut the equipment down following its normal sequence. Apply a lock and tag at every isolation point, each person fitting their own lock, then attempt a start and test to verify that the equipment cannot be energised before anyone begins work. Sign the checklist and keep it with the permit until the isolation is removed.

OSHA 29 CFR 1910.147 requires an energy control programme made up of written energy control procedures, employee training and periodic inspections. Under 1910.147(c)(6) the employer must inspect each energy control procedure at least annually, and the inspection must be carried out by an authorised employee other than the ones using the procedure being inspected, to confirm the procedure and the standard's requirements are being followed. In Australia, the WHS Regulations set the plant and electrical isolation duties and AS/NZS 4024.1603:2019 covers the isolation means designed into machinery, and this checklist is the record that each isolation followed the written procedure.

Every time equipment or plant is isolated for maintenance, repair, cleaning, inspection or any other work that could expose people to hazardous energy. That includes planned maintenance, breakdown repairs, cleaning inside machinery, changing tooling or dies, and clearing jams or blockages. A fresh checklist is required for each isolation event, even when it is the same equipment and the same people as last time, because the energy sources, the isolation points and the people affected have to be confirmed for the job in front of you, not assumed from the last one.

Applicable regulatory standards

This template is a starting point. Check the current requirements that apply to your equipment, work and location. The template alone does not establish compliance.

  • Model Work Health and Safety Regulations

    Edition: Model WHS Regulations as at 5 December 2025 (cited within as the Work Health and Safety Regulations 2011)

    Controls that can be locked off, and keeping de-energised electrical equipment from being inadvertently re-energised during electrical work.

    • reg 210: Operator controls must be identified, readily operable, located or guarded against unintended activation, and able to be locked off to disconnect all motive power.
    • reg 156: De-energised equipment must not be inadvertently re-energised while electrical work is carried out.
    • Part 4.7: General electrical safety and energised electrical work, including inspection and testing and residual current devices.

    Safe Work Australia (drafted by the Parliamentary Counsel's Committee)

  • Model Code of Practice: Managing risks of plant in the workplace

    Edition: November 2024 version (reviewed May 2018; amended 2021, 2023 and 2024)

    Model Code on isolating energy sources before maintenance, repair or cleaning, naming lock-out as the most effective procedure.

    • Section 4.5: Isolating energy sources before maintenance, repair or cleaning, with lock-out as the most effective isolation procedure.

    Safe Work Australia

  • Safety of machinery, Part 1603: Design of controls, interlocks and guards - Prevention of unexpected start-up

    Edition: AS/NZS 4024.1603:2019 (incl. Amd 1:2020)

    Machine design standard on preventing unexpected start-up: isolation, dissipating stored energy, locking devices and verifying isolation. Not a lockout procedure.

    • 5: Isolation from power supplies and dissipation or restraint of stored energy
    • 5.3: Locking (securing) devices used to hold isolating devices in the off position
    • 7.2: Design provisions that let isolation be verified before work starts

    Standards Australia and Standards New ZealandSold by the publisher

  • 29 CFR Part 1910, Occupational Safety and Health Standards

    Edition: Current eCFR text, up to date as of 2026-10-22 (read 2026-10-26)

    US lockout/tagout rule: energy control programme, procedures, devices, training and an annual inspection of each procedure.

    • 1910.147: Lockout/tagout: energy control programme, written procedures, devices, training and periodic inspection for servicing and maintenance.
    • 1910.147(c)(6): Requires an inspection of each energy control procedure at least annually, recording the machine, date, employees included and the inspector.

    US Occupational Safety and Health Administration (text via eCFR)

  • Control of Hazardous Energy: Lockout, Tagout and Alternative Methods

    Edition: ANSI/ASSP Z244.1-2024

    Voluntary US standard on control of hazardous energy, now ANSI/ASSP Z244.1-2024.

    American Society of Safety Professionals (ASSP)Sold by the publisher

Each source was read at its publisher and the page checked on 26 October 2026. The publisher's current text is the authority.

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<div style="max-width:480px;font-family:system-ui,-apple-system,'Segoe UI',Roboto,sans-serif;border:1px solid #E5E7EB;border-radius:12px;padding:20px;background:#ffffff;">
  <p style="font-size:12px;font-weight:700;letter-spacing:0.05em;text-transform:uppercase;color:#071D49;margin:0;">Free template</p>
  <p style="font-size:18px;font-weight:700;color:#071D49;margin:6px 0 0;">LOTO / isolation checklist</p>
  <ul style="margin:12px 0 0;padding-left:18px;color:#374151;font-size:14px;line-height:1.6;">
    <li style="margin:4px 0;">Isolation details: permit/reference number, date, site/location, equipment/plant being isolated and reason for isolation.</li>
    <li style="margin:4px 0;">Personnel: isolation officer and authorised person.</li>
    <li style="margin:4px 0;">Energy source identification table: energy type (electrical, hydraulic, pneumatic, mechanical, thermal, chemical, gravity, stored energy), isolation point, isolation method, lock number and tag number.</li>
    <li style="margin:4px 0;">Pre-isolation checklist (P/F/N/A): all energy sources identified, affected personnel notified, equipment shut down in normal sequence, all isolation points locked and tagged, stored/residual energy dissipated or blocked, zero energy verification completed (try test), isolation register updated, LOTO signage in place.</li>
    <li style="margin:4px 0;">Overall result: pass, fail or action required.</li>
    <li style="margin:4px 0;">Isolation verification: verified by, date and time.</li>
  </ul>
  <p style="font-size:13px;color:#6B7280;margin:14px 0 0;padding-top:12px;border-top:1px solid #E5E7EB;">Free <a href="https://www.maptrack.com/templates/loto-isolation-checklist" style="color:#071D49;font-weight:600;text-decoration:none;">LOTO / isolation checklist</a> by MapTrack</p>
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The MapTrack LOTO / isolation checklist contains 14 checks.

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