Lockout Hazard Identification & Risk Assessment Form


Companies have a duty to protect workers both while using equipment and machinery for their intended purpose and when repairing and maintaining that equipment. The primary way of fulfilling that duty is through what’s called “lockout,” which is when a equipment has been turned off and rendered inoperable with the use of a lock.  In order to ensure that all the hazards of a piece of equipment or machinery are identified, it’s necessary to do a hazard identification and risk assessment. The easiest way to do this is by using the Lockout Hazard Identification & Risk Assessment Worksheet, which lists the various types of energy involved with equipment or machinery.


  1. Identify the equipment or machinery and its location.  Use the best description possible so that no one will make a mistake later about which piece of equipment or machinery the hazard assessment is for.
  2. Review the list of hazard types in Column A and identify those that will apply to the equipment / machine being assessed.
  3. In Column C, list the tasks that will be done on this equipment/machinery.
  4. In Column D, list the specific hazards that will affect each task.  (Column B provides some typical examples that might apply).
  5. In Column E, list the method of isolating the energy that will be most effective for each hazard identified.  Examples include blocking, closing valves, undoing linkage, bleeding hydraulics, etc.
  6. If de-energization or lockout is not possible, write “alternative procedures” in this column.  This will require written procedures that provide equal or better protection to workers.
  7. In Column F clearly identify where the lockout point will be for this isolation source.  If there is a number or other method of identification use it.  Provide a drawing if possible.

Once the form is completed, use the information to develop a Lockout Procedure for that machinery or equipment.