Machine Audit Form

• Date

  Date

• Auditor

• Machine Name

• Take photos of machine from multiple sides

  Media

Machine Guarding

• Machine equipped with guards

  Yes

  No

• Machine guards prevent worker's hands, arms, or other body parts from making contact with moving parts

  Yes

  No

• Guards withstand operational forces & environment

  Yes

  No

• Guards are free of sharp edges and do not create hazards

  Yes

  No

• Guards are firmly secured and not easily removable

  Yes

  No

• Machine controls within easy reach of the operator

  Yes

  No

Safeguarding Devices

• Machine is equipped with interlocking device

  Yes

  No

• The system cannot operate in automatic mode until interlock gate is closed

  Yes

  No

  N/A

• The system will issue stop if the interlock barrier is opened

  Yes

  No

  N/A

• Closing interlock does not restart automatic operation

  Yes

  No

  N/A

• Resuming automatic operation requires deliberate action

  Yes

  No

  N/A

Guarding of Mechanical Hazards

• Gears, sprockets, pulleys, flywheels, belts, chains guarded

  Yes

  No

• Guards provided for any other hazardous moving part of machine

  Yes

  No

  N/A

Emergency Stop Devices

• Operator control station has an e-stop device

  Yes

  No

• E-stop is red with yellow background

  Yes

  No

• E-stop is unguarded

  Yes

  No

• E-stop is palm or mushroom head type

  Yes

  No

• Resetting e-stop does not initiate a restart

  Yes

  No

• Red mushroom type buttons are not used for any other function

  Yes

  No

LOTO

• Isolating device present for main electrical disconnect

  Yes

  No

• is lockable

  Yes

  No

• Isolating device present for hydraulic energy souces

  Yes

  No

• is lockable

  Yes

  No

• Isolating device present for pneumatic energy source

  Yes

  No

• is lockable

  Yes

  No

• Isolating device present for thermal energy sources

  Yes

  No

• is locable

  Yes

  No

• Isolating device present for other energy sources

  Yes

  No

• is lockable

  Yes

  No

Non-Mechanical Hazards

• Details on chemicals used in machine operations are readily available (SDS Sheets)

  Yes

  No

• Are hazards identified by signs and tags

  Yes

  No

• Electrical connections are in good repair

  Yes

  No

• Operator dress safely for job

  Yes

  No

• Worksite lighting is adequate

  Yes

  No

Training

• Workers trained in the recognition of machine hazards and the importance of using safeguards

  Yes

  No

• Is a lockout placard provided

  Yes

  No

• Work instruction provided

  Yes

  No

Maintenance

• Accurate records of modifications

  Yes

  No

• Maintenance program established

  Yes

  No