Lockout-tagout permit template (PDF) for maintenance work
Our own permit (Freigabeschein) for servicing, repair, cleaning and troubleshooting on machinery – with a table of all energy types, lock numbers per person, zero-energy verification, approval to work and a checklist for restarting.
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Particularly serious accidents happen on machinery during servicing, repair, cleaning and troubleshooting – often because someone switches the plant on while another person is still working inside, or because a pressure accumulator, a spring or a raised part still holds energy. Section 10(3) of the German Ordinance on Industrial Safety and Health (BetrSichV) therefore requires, among other things, defined responsibilities for maintenance, protection against hazardous energy and systems for approving certain work.
This permit (Freigabeschein) takes you through the lockout-tagout procedure: job and responsible persons, every type of energy with isolation point, lock number and zero-energy verification, the personal locks of everyone involved, approval to work, interruptions and finally the hand-back with a checklist for restarting. The structure is AMS Go's own template that you can adapt to your machinery.
What the template contains
- Two-page PDF permit with job, installation, validity and the persons responsible for the installation and for the work
- Table for eight types of energy with isolation point, “switched off”, lock number and zero-energy verification
- List of everyone involved with their own lock, time and signature when attaching and removing it
- Approval to work, record of interruptions and shift changes and a checklist for hand-back and restart
How to use the template
- 1
Identify energy types on site
Go to the machine with the person responsible for the work and enter the isolation point for every type of energy – main switch, valve, gate valve. Mark energy types that are not present with “N/A”. A machine-specific isolation procedure saves time here.
- 2
Lock, verify and approve
Only once every isolation point is locked, residual energy has been dissipated, zero energy verified and everyone involved has attached their personal lock does the person responsible for the installation sign the approval.
- 3
Complete the hand-back properly
After the work, go through the restart checklist: tools removed, guards refitted, everyone outside the danger zone, all locks removed by their owners. Only then is the energy restored.
Legal basis
- Section 10(2) and (3) of the Ordinance on Industrial Safety and Health (BetrSichV): maintenance based on the risk assessment, responsibilities, protection against hazardous energy, dissipating stored energy, permit systems
- Section 8(5) BetrSichV: permanent and safe isolation from every energy source, dissipation of stored energy
- Technical Rule TRBS 1112 “Maintenance” (Instandhaltung): preparation, protective measures, execution and trial run of maintenance work
- Section 8 of the Occupational Safety and Health Act (ArbSchG) and Section 13 BetrSichV: cooperation with contractors, written appointment of a coordinator where there is an increased hazard
- DGUV Regulation 3 with DIN VDE 0105-100: five safety rules for the de-energised state of electrical installations
Frequently asked questions
Is a permit for maintenance work mandatory in Germany?
The law does not prescribe a specific form. Section 10(3) BetrSichV does, however, require employers to define responsibilities and to use permit systems for certain work. Which work this covers follows from the risk assessment (Gefährdungsbeurteilung) – typically work in the danger zone of machinery, on several types of energy or with contractors. A written permit is the simplest proof.
Who signs the permit?
The split described in TRBS 1112 has proven effective: the person responsible for the installation is in charge of operating the machine, secures it and approves the work. The person responsible for the work leads the maintenance and confirms takeover and hand-back. Everyone involved records their personal lock with time and signature.
Why does everyone need their own lock?
Because that is the only way to ensure nobody can switch the machine on while someone is still working in the danger zone. Each person removes their lock only once they have left the danger zone. Where there are many isolation points, a group lockout helps: the keys to the group locks are placed in a box to which everyone involved attaches their personal lock.
You may use and adapt the template freely in your own company and for your own clients. It reflects the regulations named as they stand.
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Related guides
- Protective measures
Lockout-tagout in Germany: isolating machinery safely for maintenance
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Writing operating instructions in Germany: structure, content and duties
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Contractor management in Germany: coordinating, briefing and documenting contractors
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