Jenkins Academy of Applied Technology

Affected employee workplace instruction and verification

Lockout/Tagout. Online knowledge course resource v1.0.0. October 21, 2026.

General-industry workers operating/using equipment being serviced under energy control or working in that servicing area. Does not authorize energy-control application.

Use safe, approved training arrangements. Authorized-role verification includes equipment-specific skills; affected/other verification addresses their own duties and understanding. Do not expose a learner or have an unassigned person operate isolation devices as an exercise.

Save completed entries: fields are not stored automatically. Print or save the completed form as PDF before closing. This worksheet supports employer evidence; it is not an automatic role assignment or completed training certification.

Employer / facility and jurisdictionEmployee name and assigned roleTrainer/evaluator name and roleInstruction and verification datesEquipment / task / procedure identifier and revisionEnergy sources / magnitudes and control methods (authorized role)Notification, escalation and trainer contactsLanguage / vocabulary / assistance arrangements

Preparation

Confirm applicability, the actual role and other relevant procedures. Supply the current energy-control program, equipment procedures, approved devices, safe practice arrangement and qualified trainer access. For any exception, obtain the employer’s documented applicability decision rather than inferring one from this course.

Observe and discuss

For each item record Demonstrated, Needs correction, or Not applicable with the reason, evidence and needed correction. These response labels are Academy design choices.

Role-specific verification	Result / evidence / correction
1. Explain the purpose and use of the actual energy-control procedure and the assigned affected role.	Result and evidence
2. Identify actual protected equipment, area restrictions, locks and tags without entering an exposure.	Result and evidence
3. Explain prohibited restart/reenergization, removal and bypass attempts using workplace scenarios.	Result and evidence
4. Demonstrate understanding of before-application and after-removal/before-startup notification methods.	Result and evidence
5. Explain all tag limitations where tagout is used and the damaged/unclear-device reporting process.	Result and evidence
6. Explain actual contractor/shift interfaces, escalation contacts and retraining/change communication.	Result and evidence
7. Recognize when a requested task changes the role and requires authorized training/skills.	Result and evidence

Resolve gaps and reassess

Unresolved questions, instruction gaps or procedure/control problemsCorrection / reteaching and responsible personReassessment evidence and dateEvaluator conclusion on the assigned knowledge and skillsWhat supports this job going well, and which changes could undermine protection?Employer record location and role-assignment decision

Attach the online knowledge result separately. The employer certifies actual training with employee name and training dates and keeps it current. Record any inspection separately under paragraph (c)(6). Do not accept a quiz, signature or this uncompleted form as proof that equipment-specific skills or role understanding have been acquired.

Authority: 29 CFR 1910.147(c)(7), related task provisions, and OSHA understandable-training guidance. The worksheet layout is an Academy tool.