Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
Equipment Safety Devices
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View the lockout device condition, is the lockout condition in safe operating condition?
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Does the safety circuit appear to be in tact and properly functioning? (if applicable)
Electrical Systems
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Are the fasteners that are meant to keep the box water tight, tightened correctly and/or the correct fasteners? If there are no electrical fasteners, reply with N/A. If there are any issues with fasteners, document with a picture and a note if possible.
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Are the fasteners that are meant to keep the box water tight, tightened correctly and/or the correct fasteners? If there are no electrical fasteners, reply with N/A. If there are any issues with fasteners, document with a picture and a note if possible.
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Are electrical terminations in good condition (free from wire nuts, splices, etc.)? If there are issues with wiring, document with a photo and note if possible.
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Is the seal for the enclosure correct and in good condition? If there is seal integrity issues respond with a picture and note if possible.
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Are the electrical boxes in good condition and free of modifications such as holes, welds that warp, etc.? If there are enclosure issues please document with a picture and a note if possible.
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Is the electrical box (including electrical raceways) in good condition and labelled properly? If the answer is no to this question, please document with pictures and a note if possible.
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Are there any other electrical issues with the machine? If there are other issues please document with a photo and note if possible.
Hydraulic Systems
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Does the equipment have hydraulic systems? <br>If the answer is no to this question answer the hydraulic questions in this section with N/A.
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Are the hoses in good condition? If there are no hoses, reply with N/A. <br>If they are not, record with a picture of the hoses to show condition and a note if possible.
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In looking at the hydraulic pack, does it look to appear in a good maintenance condition? <br>If no hydraulic pack, reply with N/A. If the hydraulic pack looks in poor condition please document with pictures and a note if possible.
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Does the hydraulic system seem to be sealed in such a way to keep water out? Including breather caps, lids, etc.? <br>If no hydraulic pack, reply with N/A. If the hydraulic pack looks like water intrusion could be an issue please document with pictures and a note if possible.
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Are the hydraulic valves in good condition with all nuts holding on coils, covers on the electrical, etc.? <br>If no hydraulic valves, reply with N/A. If the hydraulic valves are not in good condition please document with pictures and a note if possible.
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Other hydraulic issues? <br>If there are other hydraulic issues to note, please take pictures and a note if possible.
Pneumatic Systems
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Are air hoses in good condition? If there are no hoses reply with N/A. <br>If there are issues with hose condition, please take pictures and a note if possible.
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Are air valves in good condition? <br>If there are no air valves reply with N/A. If there are issues with the valves, please take a picture and a note if possible.
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Are air cylinders in good condition? If there are no air cylinders reply with N/A. <br>If there are obvious issues with the air cylinders, document with a picture and note if possible.
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Other pneumatic issues? <br>If there are none reply with N/A. If there are other pneumatic issues, document with a picture and a note if possible.
Mechanical Systems
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Is the rotating equipment in good condition?<br>If there is issues with the rotating equipment, please document with a photo and a note if possible.
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Is the linear equipment in good condition?<br>If there is issue with the linear equipment, please document with a photo and a note if possible.
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Are tires, tracks, etc in good condition?<br>If not, please document with any applicable pictures and a note if possible.
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Are all additional pumps, impellers, shafts that are visible in good condition?<br>If any issues found, please document with a picture or a note if possible.
Other Issues
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Additional Issue 1 - Is there another issue that you would like to document?<br>Add any pictures and notes as necessary.
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Additional Issue 2 - Is there another issue that you would like to document? <br>Add any pictures and notes as necessary.
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Additional Issue 3 - Is there another issue that you would like to document?<br>Add any pictures and notes as necessary.
