Energy isolation · Printable resource
Energy isolation verification checklist
Walks through the isolation sequence. Identify, shut down, isolate, lock, release stored energy, verify, with space to record each energy source.
- Format
- PDF (A4) · printable web page
- For
- Authorised persons, maintenance teams and supervisors
- Version
- v1.0 · reviewed 30 October 2026
SAFETY SUTRAS · FIELD RESOURCEv1.0Energy isolation verification checklist
Use alongside your site’s written energy control procedure for this equipment. Every energy source must be listed and verified.
Equipment / tag no.
Date / time
Procedure reference
Authorised person
Preparation and isolation
- All energy sources for this equipment are identified (electrical, mechanical, hydraulic, pneumatic, chemical, thermal, gravity)
- Affected people have been told the equipment will be shut down
- Equipment is shut down using the normal stopping procedure
- Each energy source is isolated at its energy-isolating device (not a control circuit)
- Each person exposed has applied a personal lock / tag
Stored energy and verification
- Stored energy is released, restrained or blocked (springs, accumulators, capacitors, raised parts, trapped pressure, heat)
- Isolation is verified by attempting to start / operate from normal controls
- Absence of voltage / pressure is proven with suitable, checked test equipment where relevant
- Controls are returned to OFF / neutral after the verification attempt
Energy sources and isolation points
| Energy type | Isolation point | Locked by | Verified how |
|---|---|---|---|
Confirmation
Verified by (signature)
Witness (where required)
General discussion aid, not a risk assessment, permit or procedure. Adapt to your site’s hazards, legal requirements and competent advice.
SAFETYSUTRAS.COM · FREE RESOURCE · ADAPT BEFORE USEv1.0 · reviewed 30 October 2026