LOTO Isolation Log

LOTO Isolation Log
Date of Isolation

MonthDayYear
Date
Description of Work
List of Equipment out of Service
Necessary Requirements of Clear Isolation
Authorized Employee Name

First NameLast Name
Authorized Employee Email
example@example.com
Authorized Employee Phone Number
Person Continuing Work (if applicable)

First NameLast Name
Person Continuing Work Phone Number
Locks/Tags for Group Lockout or Multiple Locks/Tags
Authorized Person Signature

Clear
Should be Empty: