LOTO Verification Checklist — Digital Field Ticket

Lock-Out / Tag-Out Verification Checklist

OSHA 1910.147 Energy Control · Digital Field Ticket · Section 5.4

MXM Turbinetec LLC

Food Processing Line Sanitation

STOP — No line cleaning begins until all isolation steps below are verified complete and the facility manager signs this field ticket. Failure to follow OSHA 1910.147 energy control procedures may result in serious injury or death from unexpected energization.

Field Ticket Information

Facility / Client Name

Line / Equipment ID

Date

Authorized Employee (Lock Holder)

Facility Manager (Verifier)

Energy Sources Identified

Energy Isolation Sequence

1. Notify all affected employees that line cleaning / LOTO is about to begin2. Identify all energy sources (electrical, pneumatic, hydraulic, thermal, gravity)3. Shut down the equipment using the manufacturer's established procedure4. Isolate each energy source (disconnect, close valve, block, bleed)5. Apply individual locks and tags to each isolation point (one lock per authorized employee)6. Relieve / restrain all stored or residual energy (capacitors, springs, pressure)7. Verify isolation by attempting to start the equipment — confirm zero energy state

Required PPE & Safety Equipment

Safety glasses / face shieldHearing protectionInsulated glovesCO₂ gas monitor (audible alarm)Static-bonded blast nozzleConfined space permit (if applicable)

Field Notes / Observations

Facility Manager Verification

I verify that all energy isolation steps have been completed and confirmed per OSHA 1910.147. The equipment is in a zero-energy state and line cleaning is authorized to proceed.

Facility Manager Signature

Time Verified

Complete all steps and manager verification to authorize line cleaning.