Jenkins Academy of Applied Technology

Other employee workplace instruction and verification

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

Other employees whose work operations are or may be in areas where energy-control procedures are used. Does not replace affected or authorized instruction.

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. Confirm the employee’s duties fit the other-employee role. If duties meet the affected/authorized definition, assign that training instead.	Result and evidence
2. Identify the actual procedure warnings, protected areas and safe access arrangements.	Result and evidence
3. Explain the prohibition on restart/reenergization and interference with devices or restrictions.	Result and evidence
4. Explain all tag limitations where tagout is used, including secure attachment, legibility and environment.	Result and evidence
5. Use a safe scenario to explain reporting of damaged warnings and conflicting instructions.	Result and evidence
6. Identify the responsible contact and when changed duties require another role’s instruction.	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.