Free LOTO / isolation checklist
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A lockout/tagout (LOTO) isolation checklist is used to ensure equipment is safely de-energised before maintenance or repair. This page explains what to include, how to complete the checklist, and offers a free PDF-ready form you can download and use straight away. No sign-up required.
Last updated: 2026-02-21 · MapTrack
Commercial Director
How to use: Fill isolation details → identify all energy sources → complete pre-isolation checklist → verify zero energy → sign off → re-energise when safe → save as PDF (Print → Save as PDF in your browser).
- ✓ PDF-ready. Open and print to PDF
- ✓ Covers lock points, energy sources, tags, verification and re-energisation
- ✓ Free to use with or without MapTrack
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See the first part of the checklist below. Enter your email above to download the full LOTO isolation checklist (PDF-ready).
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.
Benefits of using a 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 from paper or static PDFs to digital forms in MapTrack, you get:
- Field users can easily scan a QR code to complete a form on mobile — unlimited users.
- Automatically get alerts when faults are identified.
- Link every form digitally as a PDF to the relevant asset, location or person.
- Receive a digital PDF copy with every submission to your email.
- Ability to share forms digitally.
- Build conditional logic (show or hide questions based on answers).
- Take pictures or attach photos — not possible with a paper-based form.
- Electronic signatures.
- Edit forms later without reprinting.
- Restrict permissions (who can view, complete or approve).
- Build forms with AI (describe what you need and MapTrack suggests the form).
Book a demo to see digital isolation checklists and permit-to-work management in MapTrack.
What to include in a LOTO isolation checklist
Our free LOTO isolation checklist includes:
- 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 complete a LOTO isolation
- Fill in the isolation details - permit number, date, site, equipment being isolated and the reason for isolation.
- Record the isolation officer and authorised person names.
- 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.
- Notify all affected personnel that the equipment is being isolated.
- Shut down the equipment following the normal shutdown sequence.
- Apply locks and tags to all isolation points. Each person working on the equipment should apply their own lock.
- Dissipate or block any stored or residual energy (e.g. bleed hydraulic lines, discharge capacitors, block raised loads).
- Perform zero energy verification - attempt to start the equipment (try test) to confirm isolation is effective.
- Complete the pre-isolation checklist, marking each item as Pass, Fail or N/A.
- When work is complete, follow the re-energisation checklist before removing locks and returning equipment to service.
In MapTrack, you can build digital LOTO checklists, attach photo evidence of lock and tag placement, trigger automatic alerts and maintain a complete isolation register, all linked to the relevant asset. Book a demo to see how.
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Back to download formWhen to use an isolation 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.
Frequently asked questions
- What is a LOTO isolation checklist?
- 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.
- What energy sources need to be isolated?
- 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.
- Who can remove a lockout?
- Only the authorised person who applied the lock should remove it. This is a fundamental principle of LOTO safety. If the person who applied the lock is unavailable (e.g. absent or injured), most organisations have a documented procedure that allows a senior authorised person or supervisor to remove the lock under strict conditions, typically requiring verification that all personnel are clear, a risk assessment and witness sign-off. The procedure must be documented in the organisation's isolation management procedure and comply with relevant Australian WHS legislation.
- Is the template free to use without MapTrack?
- Yes. You can download and use the LOTO isolation checklist for free. Open the file and use your browser's Print → Save as PDF to keep a copy. No MapTrack account required. If you later want digital isolation checklists on mobile with automatic alerts, photo evidence and audit trails, we’d be happy to show you MapTrack.
Need digital isolation checklists with automatic alerts?
Build LOTO isolation forms in MapTrack. Complete them on mobile with photo evidence of lock placement, trigger automatic notifications and maintain a digital isolation register - all linked to the relevant asset.