Information

  • Conducted on

  • Prepared by

Document Revision

Identification of Machine

  • Make / Model / Identification evidence of machine

  • Photo

  • Use

Guarding

  • Is there current mechanical guarding in place on machinery?

  • Is guarding ZERO ACCESS i.e. sufficient to prevent access to the moving parts?

  • Describe what additional controls are in place, if any?

  • Are the gaps adequate to prevent accidental access to dangerous moving parts?

  • Describe what additional controls are in place, if any?

  • Are there any unguarded nip points?

  • Describe what additional controls are in place, if any?

  • Is there a Lock Out/Tag Out system in place prior to the removal of guarding?

  • Are all electrical fixtures covered?

  • Is there a need for integrated guarding (eg two handed operation due to exposed dangerous components while in use)?

  • Describe what complementary safety controls are in place?

  • Is there suitable access for servicing eg removable section to service, maintenance, removable panels to allow access to adjust bolts etc?

  • Are guards secured eg mounting bolts tightened, grills secured?

  • Are safety isolation lock out devices (LOTO) fitted and tested as operational?

Findings

  • Were any deficiencies found?

  • What are the deficiencies?

Recommendations

  • undefined

Auditee

  • Add signature

Validation of Safety Related Parts of Control System (SRPCS)

SRPCS Validtaion

  • What type of controls are used on this machinery?

  • Have all reasonable measures been taken to place the Safety Devices far enough away from the hazards to ensure machine comes to a stop before reaching the hazard? See standards such as AS4024:2801 for guidance

  • Please detail your assumptions and how what you have done is equal to or better than the current state of knowledge - i.e. AS4024:2801

Validation Testing - Fault Analysis of SRPCS Devices Used

  • Emergency Stops & Lanyard Switches

  • Validation Test Results

  • Details of failure and remedial action required.

  • Complementary Safety Measures Used?

  • Validation Testing Results

Additional Information

  • Person Completing Report

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