Jenkins Academy of Applied Technology
Authorized employee workplace instruction and verification
Lockout/Tagout. Online knowledge course resource v1.0.0. October 21, 2026.
General-industry covered servicing and maintenance. Online knowledge component followed by employer equipment-specific training and skills verification.
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.
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. Identify actual equipment/task, each energy source, its type and magnitude, hazards and control method. Resolve discrepancies. | |
| 2. Locate the current equipment-specific procedure and identify actual isolation points, approved locks/tags and protective hardware. | |
| 3. Explain affected-employee notification and prepare/orderly shutdown under the procedure. | |
| 4. Demonstrate isolation and device application safely in the approved training arrangement. | |
| 5. Demonstrate hazardous stored-energy control and explain the response to reaccumulation. | |
| 6. Demonstrate the actual verification method safely and state what stops work when verification fails. | |
| 7. Explain and demonstrate the assigned release/restoration checks, own-device removal and required notifications. | |
| 8. Explain exceptional removal safeguards and designated authority. Do not perform unauthorized removal. | |
| 9. Demonstrate assigned group/personal-device protection and shift transfer with no gap, if applicable. | |
| 10. Explain contractor coordination and controlled testing/positioning transitions, if applicable. | |
| 11. Explain all tag limitations where tagout is used and any task/role-specific procedures. | |
| 12. Identify training-change/deficiency triggers, qualified trainer contact and unresolved issues. |
Resolve gaps and reassess
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.