• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pass or Fail

  • Did the equipment pass the safety checklist

Lock-out/Hazardous Energy Control

  • Are all sources of energy clearly labeled (i.e. E1, P1, etc.)?

  • Hazardous energy placard (e-PLAC standard) posted (for any dual source equipment)?

  • Lockable electrical and/or air lines/valves within 6 1/2 ft from the floor?

Confined Space

  • Labeled and numbered?

  • Evaluated for permit/non-permit required?

  • Potential hazard(s) identified?

  • Recorded on Plant's Confined Space Log?


  • All wiring meets Inteva Controls standards?

  • Properly Fused?

  • Limit Switches Functional?

  • Light curtains and safety mats function correctly?

  • Ground fault interrupts required/installed?

  • Voltage marked?

  • Panels have proper clearances?

  • Arc flash and shock label posted NFPA70E?

  • Non-custom equipment NRTL (i.e. UL) listed and labeled?

  • Are the electrical cords/extensions safe? Routed Safety? Less than 20 feet and protected?


  • Anti tie down/anti repeat circuitry verified?

  • Stop controls function properly and are accessible?

  • Cycle stops - Are yellow and stop upon completion of a cycle?

  • Master stops- Are red and stops machine?


  • Meet height requirements?

  • Meet lifting guidelines?

  • Cycle time identified?

  • Within operator posture limitations?

  • Within operator force limitations?

Compressed Air

  • Hand held max 30 PSI and vented?

  • Mechanical brakes on air cylinders operate correctly?

  • Properly labeled?

  • Valves labeled including operating pressure and what valve initates?

  • Muffler on exhaust?

  • Does not create a safety hazard when de-energized?

Water Lines

  • Properly labeled? (utilities labeled every 40 feet)

  • Incoming/Drain?

  • Back flow preventer(s) installed if required?

Gas Lines

  • Properly labeled? (utilities labeled every 40 feet)?

  • Direction of flow identified?

  • Pressure identified?

  • Proper exhaust?

  • Proper safety valves including lockout?

  • Safety instructions in place?

  • Training plan written for implementation?


  • Proper plumbing?

  • Valves labeled including operating pressure and what valve initiates?

  • Clearly labeled gages, preferably within operating range?

  • Does not create a safety hazard when de-energized?


  • Properly labeled? (utilities labeled every 40 feet)?

  • Direction of flow identified?

  • Pressure identified?


  • Approved through Hazardous Material Control Committee?

  • Material Safety Data Sheets provided with 100% disclosure and all ingredients within 5% of actual?

  • Safe Use Instructions provided?

  • Storage area provided?

  • Properly labeled?


  • System prints provided and current?

  • Electrical?

  • Pneumatic?

  • Hydraulic?

  • Water, Gas, Steam, Etc?

  • Ventilation?

  • Lubrication?

  • Coolant/Quench?

  • Preventative maintenance sheets have been provided?

  • Preventative maintenance frequency have been provided?

  • Maximo identification number is affixed to the equipment?

  • Maintenance has been trained on proper use/operation per instructions?

Work Place Organization plan implemented

  • Tools in marked spots?

  • All required equipment in designated locations?

  • Skip/hopper/rack locations designated- visually marked?


  • Are guards free from burrs, sharp edges, and sharp corners?

  • does guarding safely contain all material within the guarded area in case of mechanical failure?

  • Do guards contain coolant or lubricant splash?

  • Do guards permit proper visibility where necessary?

  • Do guards avoid creation of a hazard or interfering normal operation of equipment?

  • Are easy open barrier guards which cover pinch points interlocked?

  • Are guards hinged whenever possible and designed in such a manner that neither counter balance not any other mechanical aids are required to open/hold/close them?

  • Do all barrier guards installed eliminate all pinch points?

  • Are all drive unit apparatuses such as belts, cylinders, chains, sprockets, gears, and shafts totally enclosed?

  • Are all shear, crush, pinch, and coupling drive flanges completely guarded?

  • Are all turnover or rollover fixtures adequately guarded to stop access?

  • Where suspended counterweights are used and not guarded by location, are they enclosed?

  • Does light curtain installation conform to proper "safe distance" requirements?

  • Has light curtain application been entered into preventive maintenance tracking system?

  • Is proper mechanical guarding in place to prevent reaching around light curtains and into unsafe area?

  • Are robot to hard guarding distances adequate per ANSI R15.06, generally 18" from restricted space to guard?

  • Does the control safety circuit meet all requirements outlined in Inteva Standards?

Ventilation Requirements

  • Ventilation required/installed?

  • Fire detection required/installed?

  • Fire suppression system required/installed?

  • Exhaust ventilation required/installed?

  • Proper filters available/installed?

  • Mist collector's required/installed?

  • Dust collector's required/installed?

Platforms, Ladders, and Steps

  • Do treads have non-slip surfaces?

  • Are hand rails provided?

  • Are mid rails provided?

  • Toe boards, 4" high (above 48" elevation)?

  • Is a safety gate at fixed ladder/platform entrance/exit?

  • Are serviceable components accessible without climbing?

  • Are platform railings 42" high?


  • Proper lighting?

  • All sharp and protruding points have been eliminated or protected?

  • Personal protective equipment identified?

  • Emergency eyewash and safety shower installed?

  • Floor openings guarded or covered?

  • Walking surfaces are free from obstacles and posted load requirements?

  • Audible operator signals provided on conveyors, assembly lines, transfers?

  • Is a Safety fence/barrier provided?

  • Are operating noise levels <80 dBA, including documentation?

  • Operators are protected from hot/cold temperatures?

  • Operators instructions have been provided to the department?

  • Operators have been trained on proper use/operation?

  • Are safety signs installed?

  • Service personnel compliant with NFPA70E (letter of compliance signed)?

  • Service personnel have reviewed Vandalia contractor guidelines?

  • Safe work procedures/placard(s) are posted on the Machinery/Equipment?

  • Brass tag number is affixed to the equipment?

  • Fall Hazards identified and eliminated or protected?

Additional Notes

Owner of Action Items

Signatures of Auditors

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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.