Title Page

  • Site conducted

  • Equipment

  • Conducted on

  • Prepared by

  • Auditor Signature

  • Co-Auditor, if applicable

Requirements for all Safeguards

  • Do the safeguards prevent employees’ hands, arms, and other body parts from contacting dangerous moving parts?

  • Are the safeguards firmly secured and not easily removable (i.e., specialty tool needed for removal)?

  • Do the safeguards ensure that no object will fall into the moving parts?

  • Do the safeguards permit safe, comfortable, and relatively easy operation of the machine?

  • Can the machine be oiled or periodically adjusted without removing the safeguard?

  • Is there a system for shutting down the machinery before safeguards are removed?

Mechanical Hazards

  • Is the point-of-operation safeguarded for the machine?

  • Does it keep the operator’s hands, fingers, and body out of the danger area?

Power Transmission Apparatus

  • Are there any unguarded gears, sprockets, pulleys, or flywheels on the apparatus?

  • Are there any exposed belts or chain drives?

  • Are there any exposed set screws, keyways, collars, etc.?

  • Are starting and stopping controls within easy reach of the operator?

  • If there is more than one operator, are separate controls provided?

Other Moving Parts

  • Are safeguards provided for all hazardous moving parts of the machine including auxiliary parts?

  • Are all moving drive components guarded – gears, sprockets, pulleys, chains, belts, fly wheels, shafts, cylinders, fans, etc.?

  • Are all exposed shafts with the length exposed at more than half their diameter properly guarded?

Non-mechanical Hazards

  • Have appropriate measures been taken to safeguard employees against noise hazards?

  • Have special guards, enclosures, or personal protective equipment been provided, where necessary, to protect employees from exposure to harmful substances used in machine operation

Electrical Hazards

  • Is the machine installed in accordance with National Fire Protection Association and National Electrical code requirements?

  • Are there loose conduit fittings?

  • Is the machine properly grounded?

  • Is the power supply correctly fused and protected?

  • Do employees occasionally receive minor shocks while operating the machine?

Safety Circuitry

  • Are adequate emergency stops provided within the operators reach?

  • Are the emergency stops colored red with a yellow background?

  • Does the machine have redundant safety circuitry?

  • Are all safety interlocked switches, emergency stops, contacts, and devices in good working condition and operating as they should?

Machinery Maintenance and Repair

  • Are energy isolation disconnects installed for each type of energy identified on the machine?

  • Is there a machine specific LOTO procedure written for the machine?

  • Are employees trained as LOTO authorized users who perform any maintenance or repairs on the machine?

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.