Information

  • Client

  • Site

  • Conducted on

  • Prepared by

  • Location

MACHINE INFORMATION

  • Date

  • Date of last inspection

  • Make

  • Model

  • Machine Number

  • Machine Hours

  • MACHINE MUST BE INSPECTED EVERY 250 HOURS

ENGINE

  • Check all fan belts for wear and adjust

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check for oil, fuel and water leaks

  • Is the machine free from leaks?

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check for unusual noise

  • Is the machine operating without any unusual noises?

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check and service breathers

  • Are breathers in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check muffler and joints

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

DRIVES

  • Inspect belt tension and condition

  • Are the belts in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Inspect drive bearings for wear and lubrication on all belts

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Inspect drive coupling for wear and damage

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

AIR CLEANERS

  • Check Air Intake System for cracks and leaks

  • Is the air intake system in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check Air Filter element

  • Is this in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

COOLING SYSTEM

  • Check water and conditioner

  • Are they in good condition and correct level ?

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all hoses, components for leaks and condition

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check fluid level

  • Is the fluid level within safe levels

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

HYDRAULICS

  • Check oil level

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all hydraulic hoses

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check system for leaks and damage

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all support brackets

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all linkages for wear

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

PLANETARY AND TRACKS

  • Check for leaks

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Inspect track adjustment, rollers for wear and leaks, track plates

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

ELECTRICAL SYSTEM

  • Check battery terminals and check cables

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check for damage or loose cables/ plugs

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all gauges are operating

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

CONTROLS

  • Check all controls for return to neutral and leaks

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check all gauges and lights operational

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Condition of remote controls and batteries

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

VIBRATING GRIZZLY FEEDER/APRON FEEDER

  • Check feeder wear material condition

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of skirting / trays

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of feeder drive and springs

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of head/tail drum bearings (apron feeder)

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

PRODUCT CONVEYOR (Main)

  • Check belt condition

  • Are they in good condition

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Faults/Comments

  • Check condition of skirting rubbers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of rollers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of head/tail drum bearings

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Inspect conveyor condition and mounting brackets

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

PRODUCT CONVEYOR (Scalping/Dirt)

  • Check belt condition

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of skirting rubbers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of rollers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of head/tail drum bearings

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Inspect conveyor condition and mount brackets

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

JAW

  • Check wear liners including jaw plates, cheek plates and diverter plate (if fitted)

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check operation of jaw for unusual noise, bearing rumble or toggle knock

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Leaks from Jack Cylinders or wear

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Hydraulic leaks

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Broken Bolts / Fittings

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Screens secured/ Condition of feeder screens

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Capping Rubbers fitted / secured

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

SAFETY

  • Check operation of E-Stops and Lanyards

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check operation of isolation switches

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of guards and covers

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Check condition of safety warning decals

  • Are they in good condition

  • Faults/Comments

  • Repairs Required

  • Photo

  • Is it safe to operate

  • Corrective Action

  • Person Responsible?

  • Any further issues?

  • Photo

  • Is corrective action required immediately?

  • Person Responsible?

RECOMMENDATIONS ON RECTIFICATIONS

  • Recommendations on Rectifications

  • Recommendations
  • Recommendation

  • Is this a safety issue

  • Photo

  • MACHINE IS TO BE TAGGED OUT AND NOT USED UNTIL ISSUE HAS BEEN RECTIFIED

  • Person responsible

  • Due date

  • Issuance of sticker renewal date

  • This machine has been inspected as per site inspection criteria and all faults and corrective actions noted

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.