Bretford - Machine Safety Audit

• Department / Area

• Machine # and Name

• Document No.

• Conducted on

  Date

• Prepared by

• Reason for audit?

Pictures

• Pictures of machine or equipment

  Media

Action items

• Machine is positioned correctly?

  Yes

  Needed

  No

  N/A

• Anchored to floor?

  Yes

  Needed

  No

  N/A

• Walls or fencing around machine are positioned correctly?

  Yes

  Needed

  No

  N/A

• All Machine guards in place?

  Yes

  Needed

  No

  N/A

• Light curtains in place and working correctly?

  Yes

  Needed

  No

  N/A

• Pressure sensitive safety mats working correctly?

  Yes

  Needed

  No

  N/A

• E-STOP's working correctly?

  Yes

  Needed

  No

  N/A

• LOTO procedures posted on the machine?

  Yes

  Needed

  No

  N/A

• PPE sign is posted?

  Yes

  Needed

  No

  N/A

• Area free from Slip, Trip & Fall hazards?

  Yes

  Needed

  No

  N/A

• Anti-Fatigue mats in place for operator?

  Yes

  Needed

  No

  N/A

Corrective Action

• For any item marked "NO", IMMEDIATE corrective action must be taken before machine is put into service. Details below.

• For any item marked "Needed", corrective action will be taken, however, machine can still be placed into service. Details below.

Signatures

• Maintenance signature

  Sign

• Supervisor or Lead signature

  Sign

• Plant Manager signature

  Sign

• EHS Manager signature

  Sign