Lockout/Tagout Procedures Training Form
Please complete this form to confirm your participation in the Lockout/Tagout Procedures Training.
Full Name
First Name
Last Name
Department
Please Select
Maintenance
Operations
Safety
Engineering
Administration
Other
Date of Training
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously received Lockout/Tagout training?
Yes
No
Please rate your understanding of Lockout/Tagout procedures before this training.
1
2
3
4
5
Please rate your understanding of Lockout/Tagout procedures after this training.
1
2
3
4
5
Comments or questions about the training
Signature
Submit
Should be Empty: