Jacksonville HPC Machine Scan

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Shift

  1st

  2nd

  3rd

Machine Scan

• Any unguarded gears, sprockets, pulleys, or flywheels?

  Safe

  At Risk

  N/A

• Any exposed belts or chain drives?

  Safe

  At Risk

  N/A

• Any exposed set screws, key ways, collars, etc.?

  Safe

  At Risk

  N/A

• Any bodily exposure to other dangerous moving parts?

  Safe

  At Risk

  N/A

• Any part of employee observed inside machine without equipment locked out?

  Safe

  At Risk

  N/A

• Ask team members in the area if they have any safety concerns in their area?

  Safe

  At Risk

  N/A