Industrial Lockout and Tagout Kit (Word)

Written energy control procedure, two-sheet isolation record and the supporting forms for servicing and maintaining machines, process equipment and piping at an industrial site, in one editable Word file.

Word file, 67 pages including a filled example. Version v2026-10-18b.

Free sample: 5 pages from the kit (PDF)

Download the free sample

The cover, the site values table, a blank isolation record sheet, a blank group lockout roster and one filled example page. No email needed.

$79

Your file is emailed within about an hour of purchase
7-day refund

Buy the industrial lockout and tagout kit

A procedure and record set, not a single form: Sections 1 to 18, the isolation record, group lockout roster, equipment-specific procedure template, equipment inventory, exception worksheet, absent person device removal, outside personnel coordination, periodic inspection and training certifications, program review and two optional registers.
Every site value sits in one table in Section 3, so a value set once carries through the procedure.
The isolation record carries the permit to work, hot work and confined space entry numbers, and uses the same terms as those procedures in this set.
Licensed to one organization for use at one site. Each additional site needs its own purchase.
No app and no login. The file opens in Word.

Blank template only. Your site writes its own equipment-specific procedures and sets who is authorized, which devices are used and the sign-offs.

See the pages

Blank isolation record, sheet 1, with blocks for the job, linked record numbers, energy sources, shutdown checks and isolation points. — Isolation record, sheet 1: equipment and job, linked records, energy sources, before shutdown, shutdown

Blank group lockout roster where each worker logs a personal lock number on and off the group device. — Group lockout roster: group device, roster, exposure checks, crews under one lockout

Filled example isolation points table for Example Plant, Unit 2, listing valves, a breaker and blinds with their lock numbers. — EXAMPLEFilled example page. Site = Example Plant, Unit 2. Year = 2099. Not a real record.

Please read. Blank template only. It is not a legal or regulatory document, not a filled record and not approval by any regulator. It is not in force until your site fills in its values, writes its equipment-specific procedures, checks the result against the rules that apply to it, and signs the approval block. It is not a set of equipment-specific procedures: only the site can identify its own equipment, energy sources and isolation points. Your site sets who is authorized, which devices are used, how isolation is verified and the sign-offs, under the rules that apply to it. Not proof of training, not proof that the site follows any regulation, not a certification and not legal advice.

What is in the file

Instruction sheet: how to deploy the file, the name-swap table, the license and the template history
Lockout and tagout procedure, Sections 1 to 18, with document control, approval block and revision log
Section 3 site parameters: every site value in one table
LOTO-1 Isolation record (two sheets, three pages)
LOTO-2 Group lockout roster
LOTO-3 Equipment-specific energy control procedure template
LOTO-4 Equipment inventory
LOTO-5 Exception worksheet
LOTO-6 Removal of an absent person's device
LOTO-7 Outside personnel coordination
LOTO-8 Periodic inspection certification
LOTO-9 Training certification
LOTO-10 Program review
LOTO-11 Isolation record register (optional)
LOTO-12 Lock and tag register (optional)
Supplement template for site additions
One filled example isolation record, group lockout roster and equipment-specific procedure: EXAMPLE (Example Plant, Unit 2 / 2099 only)

The procedure covers purpose, scope and legal status, definitions, site parameters, roles and responsibilities, the energy control program and equipment-specific procedures, isolation methods and devices, applying energy control, verifying isolation, while the work goes on, group lockout, shift and personnel changes, release from lockout or tagout, outside personnel, training and communication, periodic inspection, records and program review, how to expand the procedure, and the crosswalks to the regulation. Each form sheet prints on its own page. You fill in your own values.

Get the file

$79

Your file is emailed within about an hour of purchase
7-day refund

Buy the industrial lockout and tagout kit