Title Page

  • Prepared By?

  • Enter the names of the Terex employees on job site today

  • Conducted on

  • Location
  • Service Job Number:

  • Machine Model:

  • Machine Serial Number:

Risk Assessment

  • Has site authority been defined and communicated to all on site?

  • Who has site authority?

  • Is the customer contact aware that you will be on site today?

  • Briefly describe work being performed and associated system(s) being worked on.

  • Is the machine indoors or outdoors?

  • Are you and the machine in a safe environment with acceptable ground and site conditions?

  • Does the task require troubleshooting and validation with any guards or safety devices removed during times where machine energy is not isolated (including machine started and running)?

  • Have you adopted 3 way communication with others on site?

  • Have you identified and communicated with others the safe location and distance from machine during troubleshooting?

  • Have you implemented use of guards, cameras, and remote testing devices whenever possible to mitigate risk during troubleshooting?

  • Is there a gravity hazard(s) that needs to be controlled by a safety pin, priming procedure or locking device?<br><br>Example: anything that can fall causing injury

  • What is the gravity hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Is there a pressure hazard that needs to be controlled?<br><br>Example: hydraulic pressure, water pressure, coolant pressure,

  • What is the pressure hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Is there a electrical hazard that needs to be controlled?<br><br>Example: contact with live parts causing shock and burns, faults which could cause fires, fire or explosion where electricity could be the source of ignition in a potentially flammable or explosive atmosphere, e.g. in a spray paint booth

  • What is the electrical hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Is there a motion hazard that needs to be controlled?<br><br>Example: conveyors moving, rotor spinning, engine running, or any unexpected movement of a part that can cause injury

  • What is the motion hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Is there a temperature hazard that needs to be controlled?<br><br>Example: hot exhaust, hot coolant, hot hydraulic oil

  • What is the temperature hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Is there a biological & chemical hazard that needs to be controlled?<br><br>Example: blood, hazardous chemicals, or battery

  • What is the biological & chemical hazard?

  • How will you control the energy?

  • How will you verify control of the energy?

  • Are you equipped with the proper PPE for the job and is it in good working condition?

  • Do you have all tools necessary for the job and are they in good working condition?

  • Does the job require rigging of any parts?

  • Is all rigging equipment inspected before use and is it suitable for the job?

  • Do you have the required rigging plans or completed a non-standard rigging assessment?

  • Does the job require the use of torches, welder, grinder or anything else that can cause a fire?

  • Do you have all necessary equipment to prevent fire, or in the case a fire does start to extinguish it?

  • Are you or other personnel suitably qualified to operate any of the equipment in use?

  • Are there other people working on the machine that are not Terex team members such as customer supplied mechanics or 3rd party technicians?

  • List all Non Terex Employees working on the machine. Non Terex team members need to be aware of the safety procedures set in place when working on Terex equipment.

  • Does the job require you to enter a confined space?<br><br>Definition of confined space: A confined space also has limited or restricted means for entry or exit and is not designed for continuous occupancy. Confined spaces include, but are not limited to, tanks, vessels, silos, storage bins, hoppers, vaults, pits, manholes, tunnels, equipment housings, ductwork, pipelines, etc.

  • What is your rescue plan for entering a confined space? There must be a minimum of 2 people present in order to enter a confined space.

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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.