Conveyor Maintenance and Repair

• Conducted on

  Date

• Prepared by

• Location
  Address

Roller Maintenance

• Does removing, replacing, one person? or transporting the roller require more than one person?

  Yes

  No

  N/A

• Does the weight of the roller exceed 50 lb?

  Yes

  No

  N/A

• Is the roller difficult to bring close to the body because of its size, bulk, shape?

  Yes

  No

  N/A

• Do employees have to stand on or walk across the conveyor belt to remove or replace the roller?

  Yes

  No

  N/A

• To remove the roller, must employees stand on an area more than 4 above ground level?

  Yes

  No

  N/A

• Is the footing unsafe? For example, are the floors slippery, inclined, or uneven?

  Yes

  No

  N/A

• Does removing or replacing the roller require fast movements to avoid being pinned or struck by the roller?

  Yes

  No

  N/A

• Does removing or replacing the roller require stressful body postures, such as bending to the floor, twisting, reaching overhead, or bending to the side?

  Yes

  No

  N/A

• Is the employee in a kneeling or squatting posture to remove or replace the roller?

  Yes

  No

  N/A

• Does the employee lie down to remove or replace the roller?

  Yes

  No

  N/A

• Are pry bars used to remove or replace the roller?

  Yes

  No

  N/A

• Is a cutting via torch required to remove or replace the roller?

  Yes

  No

  N/A

• Are tools (excluding pry bars and hammers) used to remove or replace rollers?

  Yes

  No

  N/A

• Do employees wear gloves when removing or replacing rollers?

  Yes

  No

  N/A

• Should employees wear gloves when removing or replacing rollers?

  Yes

  No

  N/A

Completion

• Name and Signature

  Sign