Title Page
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Site conducted
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Conducted on
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Prepared by
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Customer
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Location
Untitled Page
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Machine
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Machine number
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Are all dangerous parts of the machinery guarded
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Machine bolted down
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Da all of the stop buttons work
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Has training been done on the computer
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Do all the back light guards work
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Has the squaring arm been squared
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Is there Readily stop device which stops the machine in a safe way
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Does the shadow line work
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Can controls be operated safely and easily
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Does the reset button work
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Can the machine be isolated and lock off
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Customer name. I am satisfied with the work that has been completed by the engineer
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Engineer name. I have functionally checked all the equipment before leaving site and I have left everything safe. I have also made the client aware of any defects that may be present. (if any defects are present please state the equipment that is not safe to operate, giving reasons in the report)
