Machine Guarding Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Deficiency Finding

Deficiency

Defincency

• Area (Production, Warehouse, etc)

• Employee talked to

• Location

• Equipment

• Existing guard

  Yes

  No

• Recommended Safeguard

  Select Guards Devices Miscellaneous Location/Distance Administative

  • Guards
  • Devices
  • Miscellaneous
  • Location/Distance
  • Administative

• Guard types

  Fixed

  Interlocked

  Adjustable

  Self-Adjusting

• Device types

  Presence Sensing

  Safety Control

  Automation

• Miscellaneous types

  Awareness, Signs, etc

  Protective Shield

  Tool/Fixture

• Location/ Distance types

  Fence

  Configuration

  Other

• Administrative types

  Change Procedure

  Preventative Maintenance

  Training

• Probability - How Likely is an accident to happen

  Select Almost Impossible Highly Unlikely Unlikely; But Could Occur Possible But Unusual Even Chance Probable Likely Certain

  • Almost Impossible
  • Highly Unlikely
  • Unlikely; But Could Occur
  • Possible But Unusual
  • Even Chance
  • Probable
  • Likely
  • Certain

• .033

• 1

• 1.5

• 2

• 5

• 8

• 10

• 15

• Severity - It has happened, so how bad is the accident

  Select Scratch or bruise First aid OSHA recordable Restricted duty or days away Permanent Injury or loss; single limb, eye, etc Permanent injury or loss; Multiple limb, eye, etc Fatality

  • Scratch or bruise
  • First aid
  • OSHA recordable
  • Restricted duty or days away
  • Permanent Injury or loss; single limb, eye, etc
  • Permanent injury or loss; Multiple limb, eye, etc
  • Fatality

• .1

• .5

• 2

• 4

• 6

• 10

• 15

• Frequency of Exposure - How often are people in the area

  Select Annually Monthly Weekly Daily Hourly Constantly

  • Annually
  • Monthly
  • Weekly
  • Daily
  • Hourly
  • Constantly

• .5

• 1

• 1.5

• 2.5

• 4

• 5

• People - How many people are exposed in a 24hr period

  1-2 people

  3-7 people

  8-15 people

  16-50 people

  50+ people

• 1

• 2

• 4

• 8

• 12

• Difficulty to Correct - Both time and money

  Admin - Procedural, more signs, etc

  Low Tech - Easy to design/install (fixed guards)

  Medium Tech - Electronic interface (interlocks, etc)

  High Tech - Capital expense

• 1

• 2

• 3

• 4

• Photo

  Media

• Recommendations: