Machine Safety Risk Assessment Form

• Document No.

• Manufacturer

• Model

• Equipment Type

• Asset/ Serial Number

• Plant

• Line

• Date of assesment

  Date

• Assessor

Fixed Guarding

• Is there NO ACCESS to moving parts or dangerous conditions, during normal or abnormal operations?

  G

  Y

  R

• Are fixed guards robust, securely anchored with fasteners that require the use of tools to remove?

  G

  Y

  R

• Are all parts (Drives, chains, gears, shafts, etc.) adequately covered by a guard?

  G

  Y

  R

Interlocking of Moveable Guards

• Are movable guards protected with the safety rated interlocks?

  G

  Y

  R

• Do pneumatic and hydraulic systems have auto dump valves to release residual energies when interlocks are broken?

  G

  Y

  R

• Are there any obvious single points of failure of the safety system (I.e. -1 mechanical interlock switch on a guard door, 1 Air valve, etc.)?

  G

  Y

  R

• Does the safety system appear to be the appropriate CATEGORY for the equipment and it's hazards?

  G

  Y

  R

Presence Sensing

• Are presence-sensing devices the correct type for the application (I.e. light curtains instead of photo eyes, etc.)

  G

  Y

  R

• Are presence-sensing devices properly positioned (I.e. height of light curtains, distance to hazards/stopping distance, low visibility such as hoist cavities, etc.)?

  G

  Y

  R

• Are presence sensing devices that have a defined function (I.e. muting lit curtain, laser scanning suspension, etc.) controlled by safety rated devices.

  G

  Y

  R

Suspension of Safeguards

• Does the suspension of safeguards have a mode selection device (I.e a keyed jog switch, etc.) incorporated to prevent automatic or inadvertent start up?

  G

  Y

  R

• Do jog controllers require the use of two-hands and have a local e-stop button?

  G

  Y

  R

• Do the jog controls allow the user to see the entire work space? If not, does the jog function allow only one door open in the immediate area?

  G

  Y

  R

• Does the equipment display audio and visual alarms prior to machine jog movement?

  G

  Y

  R

• When in jog mode, does the equipment operate at a reduced speed significantly less than operations speed?

  G

  Y

  R

Emergency Stops

• Does the equipment have an appropriate number of e-stop buttons, located in proximity to work and/or hazard areas?

  G

  Y

  R

• Are e-stops clearly identifiable (yellow background, red head) clearly visible, and quickly accessible control devices?

  G

  Y

  R

• Does the e-stop function as an emergency stopping device regardless of operating mode?

  G

  Y

  R

• Do e-stop contain hasp covers or are they used to perform LOTO?

  G

  Y

  R

Equipment Reset & Integration

• A reset of the machine is required at a control panel upon returning from power failure, safety circuit interruption, or triggering an e-stop?

  G

  Y

  R

• Does the equipment require reset of the safety system to be local and can visual verification be performed prior to resetting safety function?

  G

  Y

  R

• Are upstream/downstream equipment controls integrated with the equipments safety system and will shutdown upon triggering an e-stop and/or safeguard failure?

  G

  Y

  R

LOTO

• Do all energy sources for the equipment have local, lockable isolation devices (I.e. disconnects, self-bleeding air valves, etc.)

  G

  Y

  R

• Does the equipment have a formally documented Energy Control Procedure and is it posted near the machine or does the operator know where to locate it?

  G

  Y

  R

• Are all energy isolation devices located outside of machine guards and access is free of hazards?

  G

  Y

  R

• Do all pneumatic systems have over-pressure protection (I.e. regulator, pressure-relief valve, etc.) and dissipate residual air when close?

  G

  Y

  R

Labels/Symbols

• Hazard warning labels or symbols are present (in the form of symbols or pictograms, or written in native language) on the equipment and its associated safeguards?

  G

  Y

  R

• Are control devices clearly identified on a drawing or pictogram located on the equipment to reference the location of critical safety controls to operators?

  G

  Y

  R

Finding/Comments