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LOTO Request Form
Submit requests for review at least 48 hours before work begins.
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Privacy notice: information submitted here is used for required LOTO document coordination, notifications, review, and recordkeeping. It may be viewed by authorized managers and admins.
Job
Select Job
AWS 69 - C25012
CSB - C25020
Date Request Submitted
Do You Require Control Power On?
Select
Yes
No
Company Name
Contact Person
Employee Number
Contact Phone
Contact Email
Date Work Will Begin
Duration of Work (Days or Hours)
Scope of Work Being Performed
Location & Equipment Being Worked On
Personnel Involved in the Work
Supervisor Verified Site-Specific LOTO Training
Select
Yes
No
Submit Request
