Businesses with hazardous energy must have a written Lockout Tagout Energy Control Plan.  Here are a few examples you can use as a template.  For a complete lockout tagout solution, including an energy control plan, training materials, and all required forms, check out the Lockout Tagout Compliance Kit.

Lockout Tagout Safety Training Compliance Kit

The sample programs provided on this page are not owned or endorsed by XO Safety.  Use them at your discretion.

Sample Written Program For Control of Hazardous Energy (Lockout / Tagout)

Sample LOTO Energy Control Plan

Download Sample Lockout Tagout Program

This Lockout Tagout Energy Control Plan is pretty simple, but it is easy to customize.  It can be a good starting point.

Pages: 17

Author: Texas Department of Insurance, Division of Workers Compensation


Control of Hazardous Energy Program

Control of Hazardous Energy Program

Download Control of Hazardous Energy Sample Program

This program provides some helpful getting started advice.  It is also very short, so it is likely a good fit for small operations with simple hazard profiles.

Pages: 5

Author: Maine Department of Labor