MPC PSSR V1 NOV24

• Site conducted

• Conducted on

  Date

• Prepared by

Equipment Information

• Equipment Type

• Equipment Manufacturer

• Make / Model of Equipment

• SN#

• Build Date

  Date

• Data Plate

  Media

• Voltage

• Amperage

• Phase

• Hz

• Operating Air Pressure

• Hydraulic Oil Reservoir - in Gallons

• Is equipment UL Approved / Listed

  Yes

  No

  N/A

Commissioning Team

• MPC Safety Rep

• MPC Engineering Rep

• MPC Quality Rep

• Equipment Manufacturer Rep

• Customer Rep (If Applicable)

Additional Team Members

• Rep Title

• Rep Name

• Rep Company

• EHS Plan Review was completed

  Yes

  No

  N/A

• FM Global Plan Review was completed

  Yes

  No

  N/A

• Municipality Approval and Permiting Received

  Yes

  No

  N/A

• As-built drawing submitted

  Yes

  No

  N/A

• Instrument calibration certificate submitted

  Yes

  No

  N/A

• All control panels and buttons clearly marked to identify function

  Yes

  No

  N/A

• All controls tested

  Pass

  Fail

  N/A

• All jog / run / stop / reset buttons all tested

  Pass

  Fail

  N/A

• All rotating parts are permanently marked with rotation arrows

  Yes

  No

  N/A

• Equipment can be visually inspected without being disassembled in all areas where product could make contact.

  Yes

  No

  N/A

• Equipment design provides quick and easy access for service and maintenance.

  Yes

  No

  N/A

• Do walkways, stairways, and ladders provide safe access to all levels.

  Yes

  No

  N/A

• Are guardrails provided on all platforms and walkways at 4' or above.

  Yes

  No

  N/A

• Have any confined spaces been identified?

  Yes

  No

  N/A

• Have confined spaces been guarded to prevent access

  Yes

  No

  N/A

• Have confined spaces been labeled with clear signage?

  Yes

  No

  N/A

• Have Egress Routes been changed due to equipment install?

  Yes

  No

  N/A

• Have employees been trained on new routes?

  Yes

  No

  N/A

• Are Egress Routes fully accessible and visible?

  Yes

  No

  N/A

• Is exit signage easily visual from work area?

  Yes

  No

  N/A

• Equipment is properly anchored?

  Yes

  No

  N/A

• All fencing, guards, rails, etc. 6' or above is anchored to the floor.

  Yes

  No

  N/A

• Equipment/Peripheral Equipment does not pose a tipping hazard

  Yes

  No

  N/A

• Overhead hazards are eliminated. (Head room @ least 7' with no obstructions below 6'8")

  Yes

  No

  N/A

• Equipment is designed to allow easy and thorough cleaning.

  Yes

  No

  N/A

• Cleaning SOP has been created.

  Yes

  No

  N/A

• All peripheral equipment, such as motors, sensors, etc. are properly mounted.

  Yes

  No

  N/A

• E-Stops are located at every workstation?

  Yes

  No

  N/A

• All conveyors 6' or longer have a life-line installed?

  Yes

  No

  N/A

• Skirting around the machine leaves a gap of no more than 18"

  Yes

  No

  N/A

• Maintenance receptacles are GFCI and receptacles external of control enclosure are covered when not in use.

  Yes

  No

  N/A

• All access panels or doors that provide access to robotic or machine cells are interlocked and outfitted with a capture key lockset.

  Yes

  No

  N/A

• There is a minimum of 18" clearance between robot movement and any fixed structure including building, fences, columns, utilities, etc.

  Yes

  No

  N/A

• Pendant controls that reach inside equipment, work cell, or robotic cell, are outfitted with an E-Stop.

  Yes

  No

  N/A

• All points of operation are properly protected.

  Yes

  No

  N/A

• Guards are designed of ridged material and require a tool to remove.

  Yes

  No

  N/A

• Guards that are not permanently affixed are interlocked.

  Yes

  No

  N/A

• Guards are designed not to deflect with personal contact.

  Yes

  No

  N/A

• Guards have no sharp edges or introduce no hazard.

  Yes

  No

  N/A

• Large guards are constructed in sections to facilitate the safe removal/reinstallation for maintenance/service

  Yes

  No

  N/A

• All rotating/moving parts are protected or guarded.

  Yes

  No

  N/A

• All pinch points are guarded.

  Yes

  No

  N/A

• All crush and shear points are guarded.

  Yes

  No

  N/A

• All electrical components are covered and secured.

  Yes

  No

  N/A

• All nip points are guarded.

  Yes

  No

  N/A

• All entanglement hazards are guarded.

  Yes

  No

  N/A

• All rotary shafts within reach are shrouded or guarded.

  Yes

  No

  N/A

• Rotating shaft ends protruding more than a 1/4" are covered, capped, or guarded.

  Yes

  No

  N/A

• All chains and sprockets are guarded.

  Yes

  No

  N/A

• All hot components are guarded or protected.

  Yes

  No

  N/A

• All power transmissions are guarded or protected.

  Yes

  No

  N/A

• All fan blades located 7' or less are guarded.

  Yes

  No

  N/A

• All cabinets and access doors/panels are outfitted with interlocks.

  Yes

  No

  N/A

• When lubrication or adjustment is done with the machine running, lubrication or adjustment points must be located outside the hazard area.

  Yes

  No

  N/A

• Alarm/horn and stack light is in place with a minimum 3 sec delay to alert EE's of start-up, fault, error, etc.

  Yes

  No

  N/A

• Light curtains are installed at distances which coordinate with equipment stopping time.

  Yes

  No

  N/A

• Equipment is designed to stop in a safe stable state in the case of power loss.

  Yes

  No

  N/A

• All Safeties tested for functionality and passed

  Yes

  No

  N/A

• Number of E-Stops

E-Stops

• E-Stop #

• E-Stop Location

• Tested

  Pass

  Fail

  N/A

• Number of Lifelines

Lifelines

• Lifeline #

• Lifeline Location

• Lifeline Tested

  Pass

  Fail

  N/A

• Number of Interlocks

Interlocks

• Interlock #

• Interlock Location

• Interlock Tested

  Pass

  Fail

  N/A

• Number of light curtains

Light Curtains

• Light Curtain #

• Light Curtain Location

• Light Curtain Tested

  Pass

  Fail

  N/A

• Greenline Audit Completed

  Yes

  No

  N/A

• All electrical components are labeled as pre specs and match electrical drawings

  Yes

  No

  N/A

• Electrical schematics / single line drawing provided

  Yes

  No

  N/A

• Is panel layout correct and matches line drawing.

  Yes

  No

  N/A

• Redundant safety circuits wired properly and to safety PLC for fail safe.

  Yes

  No

  N/A

• All electrical cabinets are lockable.

  Yes

  No

  N/A

• All safety devices wired on safety circuit for fail safe

  Yes

  No

  N/A

• All safety devices wired for a single point of reset.

  Yes

  No

  N/A

• Power feed supports equipment needs.

  Yes

  No

  N/A

• Electrical facilities support equipment needs (Breakers, panels, disconnects.

  Yes

  No

  N/A

• Wiring, cables, appliances, and connectors are of the appropriate rating based on equipment needs.

  Yes

  No

  N/A

• Power drops for permanent equipment are within approved conduit and supported from floor to ceiling by Unistrut or mounted to building walls/columns.

  Yes

  No

  N/A

• Cord reels are used only for temporary or mobile applications and are outfitted with strain relief on all cords, and a shock resistant double insulated, GFCI receptacle.

  Yes

  No

  N/A

• Equipment bonding and grounding has been verified.

  Yes

  No

  N/A

• Arc Flash Analysis has been completed and cabinets labeled.

  Yes

  No

  N/A

• All motor disconnects are located within close proximity and lockable.

  Yes

  No

  N/A

• There are no open conduit or conduit bodies.

  Yes

  No

  N/A

• There is no evidence of exposed wiring.

  Yes

  No

  N/A

• All OOS equipment is de-energized.

  Yes

  No

  N/A

• Partially demo'd electrical is disconnected at both ends and labeled.

  Yes

  No

  N/A

• All electrical cords and wires are protected from coming into contact with sharp edges such as cabinets, shelves, equipment parts, etc.

  Yes

  No

  N/A

• There are an adequate number of receptacles installed to support equipment and workarea.

  Yes

  No

  N/A

• GFCI's are installed in potentially wet areas.

  Yes

  No

  N/A

• All knockouts and openings in electrical cabinets and other facilities are covered with blanks or appropriate means.

  Yes

  No

  N/A

• All covers, panels, and doors are secure.

  Yes

  No

  N/A

• Equipment is free of exposed wiring.

  Yes

  No

  N/A

• Conduit or receptacles are not mounted to equipment with the exception of manufacturer installed maintenance receptacles.

  Yes

  No

  N/A

• Low voltage wiring is properly secured to prevent snags or tripping hazards.

  Yes

  No

  N/A

Eyewash Stations

• Eyewash stations are located within 10 walking seconds of any eye hazard classified as "high risk"

  Yes

  No

  N/A

• Eyewash stations are accessible and ready for use.

  Yes

  No

  N/A

• Eyewash inspection has been added to maintenance schedule.

  Yes

  No

  N/A

Emergency Shower

• Emergency shower is located within 10 walking seconds of any skin hazard classified as "high risk"

  Yes

  No

  N/A

• Emergency shower is accessible and ready for use.

  Yes

  No

  N/A

• Emergency Shower inspections have been added to maintenance schedule.

  Yes

  No

  N/A

• EM Lighting properly located and illuminates work area and egress

  Yes

  No

  N/A

• Has the egress path been changed due to this equipment add?

  Yes

  No

  N/A

• Have employees been trained on new egress?

  Yes

  No

  N/A

• Have site evac maps been updated?

  Yes

  No

  N/A

• Have site drawings (including life safety drawing) been updated?

  Yes

  No

  N/A

• Have sprinkler changes/upgrades been completed?

  Yes

  No

  N/A

• Fire extinguishers are appropriately located.

  Yes

  No

  N/A

• Appropriate extinguisher types have been selected.

  Yes

  No

  N/A

• Fire extinguisher location map has been updated with the vendor.

  Yes

  No

  N/A

• Fire extinguisher monthly inspections are scheduled.

  Yes

  No

  N/A

• Non-conductive clearing tools are located at areas such as heat tunnels, where product may get jammed and cause fire.

  Yes

  No

  N/A

• A master lockable air dump is installed and within arm's reach of master electrical disconnect.

  Yes

  No

  N/A

• Dump valve evacuates all pressurized air within the machine.

  Yes

  No

  N/A

• All pneumatic components accessible for maintenance and adjustment (Filter heads, cylinders, solenoids, etc.)

  Yes

  No

  N/A

• All filters, regulators, and lubricators are fitted with a pressure gauge.

  Yes

  No

  N/A

• All air components are rigidly mounted and protected.

  Yes

  No

  N/A

• Air tubing in flexible areas are properly bundled together.

  Yes

  No

  N/A

• Air tubing mounted and protected from "whipping"

  Yes

  No

  N/A

• Air tubing and fittings are properly rated for application.

  Yes

  No

  N/A

• Air filter housing caged or guarded.

  Yes

  No

  N/A

• Air lines are free from leaks (including fittings).

  Yes

  No

  N/A

• Cylinders equipped with cushions or bumpers.

  Yes

  No

  N/A

• Booster tank pressure recovers w/ each cycle.

  Yes

  No

  N/A

• Piping tracing complete.

  Yes

  No

  N/A

• All piping is labeled, guarded, and insulated.

  Yes

  No

  N/A

• Proper use of piping and flanges.

  Yes

  No

  N/A

• Correct gaskets and bolting used.

  Yes

  No

  N/A

• Piping is properly supported and protected from vibration.

  Yes

  No

  N/A

• Isolation valves, handles, and stored energy labeled.

  Yes

  No

  N/A

• Adequate drains, flush points, and purge connections supplied for maintenance.

  Yes

  No

  N/A

• Process and service connections correct.

  Yes

  No

  N/A

• All valves are lockable.

  Yes

  No

  N/A

• All energy control points are lockable

  Yes

  No

  N/A

• All energy control points are clearly labeled.

  Yes

  No

  N/A
Energy Control Points

• Energy Type

• Equipment Specific Procedures created and posted.

  Yes

  No

  N/A

• Have ESP been tested?

  Pass

  Fail

  N/A

• Have APMs been reviewed, documented, and posted?

  Yes

  No

  N/A

• APM information available to Operators.

  Yes

  No

  N/A

• All Operators, Maintenance, and other affected team members have been trained on LOTO ESP's and APM's.

  Yes

  No

  N/A

• All blocking devices are integrated into the equipment.

  Yes

  No

  N/A

• Special LOTO devices/tools have been included.

  Yes

  No

  N/A

• Equipment is registered in EAM.

  Yes

  No

  N/A

• PM schedule has been entered into EAM.

  Yes

  No

  N/A

• Operator Manual has been provided.

  Yes

  No

  N/A

• Maintenance Manual has been provided.

  Yes

  No

  N/A

• Parts list is called out in Maintenance Manual.

  Yes

  No

  N/A

• High rotation spare parts are on order.

  Yes

  No

  N/A

• Maintenance training has been completed.

  Yes

  No

  N/A

• Any special tools needed are ordered.

  Yes

  No

  N/A

• 3rd Party Service Contract is set-up.

  Yes

  No

  N/A

• Programing and recipe backups are on network.

  Yes

  No

  N/A

• A clear, delineated walkway provides access to the equipment.

  Yes

  No

  N/A

• Walkways and aisleways are clearly painted.

  Yes

  No

  N/A

• Walkways are protected/guarded from forklift traffic.

  Yes

  No

  N/A

• Walkways and work areas are free of slip, trip, and fall hazards.

  Yes

  No

  N/A

• Equipment footings, casters, cables, or peripheral equipment does not pose a trip or bump hazard.

  Yes

  No

  N/A

• Work areas are not cluttered or cramped.

  Yes

  No

  N/A

• If maintenance or operators are expected to enter a machine area for regular service, hand holds, and integrated steps are provided.

  Yes

  No

  N/A

• Work areas and walkways are free of suspended bump hazards.

  Yes

  No

  N/A

• Lilly pads or solid crosswalk belting are installed in areas where team members are expected to cross a conveyor.

  Yes

  No

  N/A

• All holes or gaps 2" or more in walking/working surfaces must be covered (secured) or filled.

  Yes

  No

  N/A

• All grating is anchored.

  Yes

  No

  N/A

• All surface railings have 42" top rail and 21" mid-rail with a 4" toe board.

  Yes

  No

  N/A

• Top railings on stairs are between 30-34" with a mid-rail between.

  Yes

  No

  N/A

• Minimum stair width is 22"

  Yes

  No

  N/A

• Portable Safety work stairs are provided in all areas where frequent access to elevated areas is needed (Baler Chutes, Conveyors, etc.)

  Yes

  No

  N/A

• Have fit for duty tests requirements been updated to reflect new equipment/processes?

  Yes

  No

  N/A

• Need for stooping, bending, stretching, and over reaching has been eliminated or minimized.

  Yes

  No

  N/A

• Need to carry, push, or pull heavy loads has been eliminated or minimized.

  Yes

  No

  N/A

• Hand position for all heavy work is 2-8" below elbows.

  Yes

  No

  N/A

• Standing work stations have work surfaces of between 34-40" deep.

  Yes

  No

  N/A

• Sitting work stations have a surface between 26-30" deep.

  Yes

  No

  N/A

• Forward reaches are limited to 20"

  Yes

  No

  N/A

• Reaches below the knees or above the shoulders are eliminated or minimized.

  Yes

  No

  N/A

• Twisting beyond 45 degrees is eliminated.

  Yes

  No

  N/A

• Antifatigue mats are used in areas where team members must stand for long periods of time.

  Yes

  No

  N/A

• All local, state, and federal permits have been received.

  Yes

  No

  N/A

• List all permits needed (Air, Waste, SPCC, SWPPP, Etc.)

• Asbestos survey completed (Buildings built before 1982)

  Yes

  No

  N/A

• Mapping for permits such as SPCC or Air Permits has been updated.

  Yes

  No

  N/A

• Backflow prevention has been installed and registered with the municipality to prevent contamination of potable water supply.

  Yes

  No

  N/A

• Waste handling plan has been reviewed by EHS and Quality.

  Yes

  No

  N/A

• USDA has been notified of changes (If Applicable)

  Yes

  No

  N/A

• Yes

  No

  N/A

• Appropriate signage installed.

  Yes

  No

  N/A

• Sharp edges on equipment, guides, chutes, etc. has been eliminated.

  Yes

  No

  N/A

• Noise levels have not been read at or above 85 dBs

  Yes

  No

  N/A

• If above 85 dBA, a 8hr time weighted average must be explored and a hearing conservation program must be initiated.

• Adequate lighting is provided.

  Yes

  No

  N/A

• Offices, laboratories, and show rooms: 500 lux

• Factories and workshops: 750 lux

• Warehouse loading bays: 300–400 lux

• Lobbies, corridors, and stairwells: 200 lux

• Warehouse aisles: 100–200 lux

• New chemicals have been reviewed and approved by EHS & Quality

  Yes

  No

  N/A

• New chemical SDSs have been received and uploaded

  Yes

  No

  N/A

• Affected team members have been trained on new chemicals

  Yes

  No

  N/A

• New PPE requirements have been reviewed and approved by EHS

  Yes

  No

  N/A

• New PPE has been sourced and available

  Yes

  No

  N/A

• Affected team members have been trained on PPE.

  Yes

  No

  N/A

• Site lift truck fleet adequate to support new equipment.

  Yes

  No

  N/A

• All lifts, hoists, cranes, and booms have be certified by 3rd party.

  Yes

  No

  N/A

• Hazard warning signage has been installed.

  Yes

  No

  N/A

• All HOT equipment components have been labeled.

  Yes

  No

  N/A

• Operator training, including safety considerations, have been completed.

  Yes

  No

  N/A

• Operating SOPs and Work Instructions have been submitted.

  Yes

  No

  N/A

• Make shift appliances such as extension cords, rope, zip-ties, hoses, tape, banding, etc. have been removed.

  Yes

  No

  N/A

• Proper floor drainage is provided for steam, wet processes, condensers, etc.

  Yes

  No

  N/A

• Spill procedures have been documented.

  Yes

  No

  N/A

• Responsible team members have been trained on spill response procedures and methods.

  Yes

  No

  N/A

• Springs and other "under tension" components have been labeled, and controlled/protected.

  Yes

  No

  N/A

• Enclosures are free from combustibles.

  Yes

  No

  N/A

• All flammable liquids are stored in flammable cabinets.

  Yes

  No

  N/A

• Cabinets that will be opened during service and maintenance are outfitted with props or locking access doors to prevent unintended closure.

  Yes

  No

  N/A

• All fencing and guardrails are properly anchored to the floor.

  Yes

  No

  N/A

• All lasers have been secured and properly shielded.

  Yes

  No

  N/A

• General ventilation of the area is adequate.

  Yes

  No

  N/A

• Equipment specific ventilation is appropriate.

  Yes

  No

  N/A

• Yes

  No

  N/A
Critical Items (Completed prior to start-up)

• Task Item

Non-Critical Items (Completed by due date)

• Task Item

Sign-Offs

• EHS Rep

  Sign

• Engineering Rep

  Sign

• Quality Rep

  Sign

• Site Rep

  Sign

• Customer Rep

  Sign

• Vendor Rep

  Sign

• Additional Notes: