Machine Information
  • Machine Make

  • Machine Model

  • Machine Number

  • Photo of Machine

  • Photo of Possible Point of Operation Areas

  • Type of Guarding

Requirements for All Safeguards

  • Do the safeguards provided meet the minimum OSHA requirements?

  • Do the safeguards prevent workers’ hands, arms, and other body parts from making contact with dangerous moving parts?

  • Are the safeguards firmly secured and not easily removable?

  • Do the safeguards ensure that no objects will fall into the moving parts?

  • Do the safeguards permit safe, comfortable, and relatively easy operation?

  • Can the machine be oiled without removing the safeguard?

  • Is there a system for shutting down the machinery before safeguards are removed?

  • Can the existing safeguards be improved?

Mechanical Hazards (The point of operation)

  • Is there a point-of-operation safeguard provided for the machine?

  • Does it keep the operator’s hands, fingers, body out of the danger area?

  • Is there evidence that the safeguards have been tampered with or

  • Could you suggest a more practical, effective safeguard?

  • Could changes be made on the machine to eliminate the point-of-operation
    hazard entirely?

  • Is adequate safety distance being used as a primary control for the

Mechanical Hazards (Power Transmission Apparatus)

  • Are there any unguarded gears, sprockets, pulleys, or flywheels on the

  • Are there any exposed belts or chain drives?

  • Are there any exposed set screws, key ways, collars, etc.?

  • Are starting and stopping controls within easy reach of the operator?

  • If there is more than one operator, are separate controls provided?

Mechanical Hazards (Other Moving Parts)

  • Are safeguards provided for all hazardous moving parts of the machine
    including auxiliary parts?

Non-Mechanical Hazards

  • Have appropriate measures been taken to safeguard workers against noise hazards?

  • Have special guards, enclosures, or personal protective equipment been provided, where necessary, to protect workers from exposure to harmful substances used in machine operation?

Electric Hazards

  • Is the machine installed in accordance with National Fire Protection Association (NFPA) and National Electrical Code (NEC) requirements?

  • Are there loose conduit fittings?

  • Is the machine properly grounded?

  • Is the power supply correctly fused and protected?

  • Do workers occasionally receive minor shocks while operating any machine?


  • Do operators and maintenance workers have the necessary training in how and why to use the safeguards?

  • Have operators and maintenance workers been trained in where the safeguards are located, how they provide protection, and what hazards they protect against?

  • Have operators and maintenance workers been trained in how and under what circumstances guards can be removed?

  • Have workers been trained in the procedures to follow if they notice guards that are damaged, missing, or inadequate?

Protective Equipment and Proper Clothing

  • Required Personal Protective Equipment

  • Is personal protective equipment required?

  • If protective equipment is required, is it appropriate for the job, in good condition, kept clean and sanitary, and stored carefully when not in use?

  • Is the operator dressed safely for the job (i.e., no loose-fitting clothing or jewelry)?

Machinery Maintenance and Repair

  • Have maintenance workers received up-to-date instruction on the machines they service?

  • Do maintenance workers lock out the machine from its power sources before beginning repairs?

  • Where several maintenance persons work on the same machine, are multiple lockout devices used?

  • Do maintenance persons use appropriate and safe equipment in their repair work?

  • Is the maintenance equipment itself properly guarded?

  • Are maintenance and servicing workers trained in the requirements of 29 CFR 1910.147, lockout/tagout hazard, and do the procedures for lockout/tagout exist before they attempt their tasks?

Additional Hazards/Concerns or Safe Behaviors

    Hazard/Concern or Safe Behavior
  • Hazard/Concern or Safe Behavior:

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  • Marsh & McLennan Loss Control Representative's Signature:

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