Page 1
Machine Information
Machine Name
Machine Model
Machine Serial Number
Machine Location
Machine Manufacturer
Machine Age (years)
Safety Features
Are all guards and protective devices in place and functioning properly?
Are emergency stop buttons clearly marked and accessible?
Are warning labels and signs clearly visible?
Is machine lockout/tagout procedure in place and followed?
Are operator training records up-to-date?
Mechanical Hazards
Are there any exposed moving parts that could cause entanglement?
Are there any pinch points that could cause crush injuries?
Are loads or components adequately supported to prevent falling hazards?
Are there any cutting or shearing edges that could cause lacerations?
Are machine stability and tipping hazards properly addressed?
Electrical Hazards
Are electrical panels and components properly enclosed and labeled?
Are electrical cords and cables in good condition and not creating tripping hazards?
Is the machine properly grounded to prevent electric shock?
Are proper lockout/tagout procedures in place for electrical maintenance?
Are the machine's electrical systems regularly inspected and maintained?
Environmental Considerations
Is the machine located in a well-ventilated area to control air quality?
Is the machine's noise level within acceptable limits?
Are there proper lighting conditions around the machine?
Is the machine placed on a stable, level surface to prevent tipping?
Are there any environmental conditions that could affect the machine's operation?
Maintenance and Inspections
Is a preventive maintenance program in place for the machine?
Are maintenance records and logs kept up-to-date?
Are scheduled inspections being performed and documented?
Are replacement parts and supplies readily available?
Is the machine shutdown and locked out prior to maintenance activities?
Overall Risk Assessment
What is the overall risk level associated with this machine?
Provide a brief summary of the key risks and recommendations for mitigation