Title Page

  • Conducted on

  • Prepared by

  • Location
  • Department/Areas Reviewed:

  • Completed by:

  • Date of GEMBA walk:

  • If any answers are NO, provide the tier board number and owner to correct the issue in the action section

Machine Safety

  • Are interlocks working properly on machines? (Limit switches, light curtains, safety mats...ect)

  • Are machines guarded to prevent contact with moving parts?

  • Are areas outside of normal point of use guarded such that covers cannot be easily removed without special tools

  • Are fixtures in use to establish minimum clearance of 4 inches from machine to hands/fingers to prevent hands/fingers from being pinched/crushed?

  • Do Team Members know to check to see if interlocks and guards are functioning properly on the machines before they start working on them?

  • For stand-up and bench grinders, is the opening between the tongue guard and the edge of the grinding wheel ΒΌ inch or less?

  • Are stand-up machines bolted to the ground or wall?

  • Are foot pedals guarded to prevent accidental activation?

  • Are fixed guards secured such that they cannot be easily removed without special tools?

  • Are warning signs posted warning team members of hazards behind guarding? (pinch point, crush hazzard, electrocution ect)

  • Are Emergency Stops readily accessible by the Team Member when operating the machine? Are they clearly marked?

  • Do Maintenece TM's use proper LOTO when performing maintenance, service or when troubleshooting machines?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.