Title Page
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Site conducted
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Conducted on
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Location
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Assessor Name
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Equipment
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Asset Number
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Area
Suitability of Work Equipment
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Is the equipment suitable for it's intended purpose?
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Please state why the machine is not suitable
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Does the equipment location pose a risk to health and safety of persons?
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Please state all risks and escalate to area manager
Maintenance
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Is the asset inspected at regular intervals
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Please state why the asset is not part of a regular inspection
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Is the equipment inspected for any deterioration that may result in risks to personnel?
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Please state why the asset is not inspected for deterioration
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Where fitted, are the safety and protection devices periodically tested and recorded?
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Explain why safety devices are not tested
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Is the maintenance history available?
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Explain why history is not available
Information & Instruction
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Do you consider all relevant health and safety information, and where required written instructions e.g SOP have been made available at the asset location?
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Please explain what additional measures are required
Conformity with Community Requirements
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Is the equipment CE marked?
Dangerous Parts of Machinery
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Are the "Dangerous Parts" of this equipment suitably guarded?
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Ensure machine is locked out and escalate to area manager
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Is it possible to bypass any guards or protective devices without the need for a tool?
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Expand on how bypass can occur
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Where guards are not fitted, are suitable risk reduction measures in place to control danger to personnel?
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Ensure machine is locked out and escalate to area manager
Protection Against Specific Hazards
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Is there any reasonable probability of any article or substance being ejected, falling, rupturing, breaking, being thrown out, disintegrating, catching fire, overheating or exploding?
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Expand on issues
High or Very Low Temperature
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Are there parts of the equipment that could cause a burn, scald or sear protected?
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Are specific parts appropriately protected
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Ensure machine is locked out and escalate to area manager
Controls
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Are the controls for starting, stopping and controlling the equipment clearly identifiable and safe to use?
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Ensure machine is locked out and escalate to area manager
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Is it likely the controls could be inadvertently, accidentally or self activated?
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Expand on how asset could be activated
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Are combined stop and start controls designed so that the stop function has priority following release of the control?
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Is the stop control easy to use and will its activation bring the equipment to a safe condition in a safe manner?
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Expand on the issue
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Where fitted confirm that the Emergency Stop is readily accessible and NOT combined with the Stop control.
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Explain why same circuit is used
Isolations
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Is it possible to safely isolate the equipment's energy supplies?
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Explain why isolation is not possible
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Explain isolation method
Stability
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Is the equipment securely mounted and stable?
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Escalate to area manager
Lighting
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Is the local lighting sufficient?
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Escalate to Asset Care
Maintenance Operations
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Can maintenance be performed without risk to persons (using appropriate measures)?
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Explain exposed risk
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Are there likely to be any hazardous substances generated by the equipment or equipment near by that may cause harm whilst performing maintenance?
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List all relevant substances
Markings & Warnings
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Is the equipment appropriately marked for reasons of health and safety, and so that the equipment can't be confused with similar equipment?
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Outline what markings are required
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Are any warning signs or warning signals for the reasons of health and safety clearly visible/audible?
Mobile Work Equipment
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Is the equipment suitable for carrying persons safely?
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Is the operator protected by roll over protection?
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Explain why roll over protection is not required
Lifting Equipment
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Is the equipment used for lifting and subject to independent inspection (LOLER)?
Sign Off
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Name and signature of assessor