Machine Guarding, Electrical Safety, LOTO, and Risk Assessment

• Conducted on

  Date

• Location

• Machine Number

1.0 Machine Guarding

• 1.1 - 1910.211 - Is machine guarding in place

  Yes

  No

  N/A

• 1.2 - 1910.211 - Are machine guards properly secured (bolted to machines or frames)

  Yes

  No

  N/A

• 1.3 - 1910.211 - Are there any exposed pinch points

  Yes

  No

  N/A

• 1.4 - ANSI B 11 - Are interlocks working properly

  Yes

  No

  N/A

• 1.5 - ANSI B 11 - Are interlocks integrated into guarding to prevent operators from reaching hazards.

  Yes

  No

  N/A

• 1.6 - 1910.212 (a)(5) - Does the fan guard have a gap more than 1/2 inch

  Yes

  No

  N/A

2.0 Electrical Safety

• 2.1 - 1910.303 - Are control panels blocked (minimum 3 foot clearance or width of control panel door, whichever is larger)

  Yes

  No

  N/A

• 2.2 - 1910.303 - Are control panels properly closed (locking clips in place should also be checked)

  Yes

  No

  N/A

• 2.3 - 1910.303 - Does machinery have loose wires, broken insulation, or places on cord that is taped with electrical tape

  Yes

  No

  N/A

• 2.4 - 1910.304 - Are grounding pins missing from plugs

  Yes

  No

  N/A

• 2.5 - 1910.144 - Is an E-Stop located near the operator

  Yes

  No

  N/A

• 2.6 - 1910.144 - Is E-Stop a red button and is it properly identified as an E-Stop

  Yes

  No

  N/A

3.0 Lock out Tag out

• 3.1 - 1910.333 - Are lock out tag out procedures located at the machine

  Yes

  No

  N/A

• 3.2 - 1910.333 - Have the lock out tag out procedures been reviewed within the last year

  Yes

  No

  N/A

• 3.3 - 1910.33 - Does the operator have their lock out tag out lock with them

  Yes

  No

  N/A

Risk Assessment

• Likelihood of injury

  Low

  Medium

  High

• Severity of Injury

  Low

  Medium

  High