New Equipment Health & Safety Review Form

• Site conducted

  Select

• HSF 113.1

• New Equipment Health & Safety Review Form
  

• Conducted on

  Date

• Equipment:

• Asset #:

• Location:

• Project Champion:

• EHS Department Representative:

General Safety Issues:

• Law and Regualtion Compliance: Do you suspect non compliance may occure due to this change (local regulations, use of asbestos, fire risk asst, environmental issue, needed permits, etc.)? If yes, are there any alternatives?

  Yes

  No

  N/A

• Emergency Preparedness: Do we need to develop catastrophic failure plan recovery for this change, such as:Electrical Power Failure recovery, Material Spillage or Evaporation recovery, etc. Does this change will block or weaken evacuation function? Is emergency lighting and signs sufficient?

  Yes

  No

  N/A

• Are contractors being used qualified for the work being performed based on the sites Contractor Safety Program?

  Yes

  No

  N/A

• Are emergency stop buttons in appropriate locations and easy to reach.<br>

  Yes

  No

  N/A

• Do emergency stop buttons have a yellow background or yellow "stem"?

  Yes

  No

  N/A

• Do the e-stop buttons fully de-energize/stop all equipment motions?<br>

  Yes

  No

  N/A

• Are all other controls and displays easy to read, reach, and operate?<br>

  Yes

  No

  N/A

• Have bump/trip hazards been properly identified and adequately marked? Have slip/trip/fall hazards been eliminated?

  Yes

  No

  N/A

• Do fixed stairs have correct rise and run dimensions and railings as required?<br>

  Yes

  No

  N/A

• Do working platforms over 4 feet above ground level have correct railings and toe boards on all open sides?<br>

  Yes

  No

  N/A

• If fall protection is required, are there engineering or adminstraative solutions in place?

  Yes

  No

  N/A

• Are work surfaces free from sharp edges?<br>

  Yes

  No

  N/A

• Electrical expusre risk has been evaluated to ensure their are no bare wires, high and low voltage has been seperated, logic access ports are pulled to the outside of the cabinets, etc.?

  Yes

  No

  N/A

• Is electrical grounding built into the system to ensure that machine and parts moving through the process have adequate static dissipation?<br>

  Yes

  No

  N/A

• Are commonly changed parts and areas of equipment requiring regular maintenance (electrical panels, etc.) easily accessible?<br>

  Yes

  No

  N/A

• Is there adequate number of nearby electrical outlets in order to avoid the use of extension cords?<br>

  Yes

  No

  N/A

• Is electrical conduit located such that it will not be used as a "step"?<br>

  Yes

  No

  N/A

• Are the fronts of electrical panels kept clear and is the area labeled/marked?<br>

  Yes

  No

  N/A

• Is there enough access space to get necessary lifting devices to the machine?<br>

  Yes

  No

  N/A

• Are nearby fire extinguishers, eye wash stations, safety showers accessible and not blocked by equipment? Do they comply with corporate guidelines? <br>

  Yes

  No

  N/A

• If new confined spaces are now created, have they been labeled with signs and included in the H&S Confined Spaces policy/inventory 402?<br>

  Yes

  No

  N/A

• Have piping runs containing liquids or gases been labeled?<br>

  Yes

  No

  N/A

• Has additional required PPE been identified, provided, and added to the EHS PPE policy 206?<br>

  Yes

  No

  N/A

• Do you suspect any negative impact to thermal stress due to this change? If yes, are there any engineer or administrative solution to minimize the risk of thermal stress?

  Yes

  No

  N/A

• Special Equipment: If special equipment is added/needed (i.e. cranes, hoists, pressure vessels, elevators, conveyors, etc ) which require special maintenance, inspection and operation license, been updated in their respected programs and accounted for?

  Yes

  No

  N/A

• Do you suspect any increase risk of firing or has any negative impact to Fire Protection system (such as fire detection and alarm system, fire hydrant, fire wall, fire door, sprinkler, etc) ?

  Yes

  No

  N/A

• Has Hot Work been accounted for during the instalation or operatioanl process? (Goal is to eliminate to need to perform hot work outside of the designated area.)

  Yes

  No

  N/A

• Has required H&S training been identified? (Note what training is required for whom)<br>

  Yes

  No

  N/A

• Have any new or updated tasks been added to the JSA Task list and evaluated for criticality?

  Yes

  No

  N/A

Machine Guarding:

• Does guarding prevent hands, arms or other body parts from making contact with moving parts?<br>

  Yes

  No

  N/A

• Are machine guards firmly secured and not easily removable?<br>

  Yes

  No

  N/A

• Do the safeguards ensure that no object will fall into the moving parts?

  Yes

  No

  N/A

• Does machine guarding allow safe, comfortable, and relatively easy equipment operation without creating any additional hazards?<br>

  Yes

  No

  N/A

• Can the machine be oiled or lubricated without removing the safeguards?

  Yes

  No

  N/A

• If non-fixed guards are opened does the equipment stop?

  Yes

  No

  N/A

• Are hinged access doors electrically interlocked and de-energize/stop all equipment motion?<br>

  Yes

  No

  N/A

• Can the existing safeguards be improved?

  Yes

  No

  N/A

• Are there any unguarded gears, sprockets, pulleys, or flywheels on the apparatus?

  Yes

  No

  N/A

• Are there any exposed set screws, key ways, collars, etc.?

  Yes

  No

  N/A

• Is the Safety System design a Category 3 which achieves Control Reliability? (Interlocks/Presence Sensing Devices wired together to a safety relay then to two contactors.) (ANSI B11.19)

  Yes

  No

  N/A

• Are all energy sources capable of being locked out?<br>

  Yes

  No

  N/A

• Where necessary, have machine-specific LOTO procedures been prepared and posted? (example: not necessary on single energy source plugged equipment) <br>

  Yes

  No

  N/A

• Have heat sources been guarded to avoid the risk of burns?<br>

  Yes

  No

  N/A

Ergonomic Issues:

• Does the workspace allow for full range of movement by the operator?<br>

  Yes

  No

  N/A

• Is there enough space provided to allow the operator to face the object for lifting?<br>

  Yes

  No

  N/A

• Is the operator able to vary posture at the workstation?<br>

  Yes

  No

  N/A

• While sitting, can the operator place legs under the work area without overreaching?<br>

  Yes

  No

  N/A

• Can a forceful exertion be done with the wrists straight? <br>

  Yes

  No

  N/A

• Are forceful pushing or pulling forces kept at a minimum?<br>

  Yes

  No

  N/A

• Is repetitive or prolonged posture exertion kept at a minimum?<br>

  Yes

  No

  N/A

• Is there clearance on the operation controls for gloves, if required?<br>

  Yes

  No

  N/A

• Is there minimal exposure to vibration?<br>

  Yes

  No

  N/A

• Is the forward infrequent (4-5 times/hour) reach less than 28 inches (torso to object)?<br>

  Yes

  No

  N/A

• Reach=

• Is the forward repetitive reach less than 18 inches (torso to object)?<br>

  Yes

  No

  N/A

• Reach=

• If a standing workstation, does the height of the work surface adjust between 35 to 42 inches?<br>

  Yes

  No

  N/A

• Height=

• Is the height of non-adjustable work surfaces at or close to 35 inches?<br>

  Yes

  No

  N/A

• Height=

• Is the workstation designed to reduce or eliminate the following:

• Bending or twisting of the wrist?<br>

  Yes

  No

  N/A

• Reaching above the shoulder?<br><br>

  Yes

  No

  N/A

• Static muscle loading?<br>

  Yes

  No

  N/A

• Full extension of the arms?<br>

  Yes

  No

  N/A

• Raised elbows?<br>

  Yes

  No

  N/A

• Bending or twisting of the back?<br>

  Yes

  No

  N/A

• Bending or twisting of the trunk?<br>

  Yes

  No

  N/A

• Crouching?<br>

  Yes

  No

  N/A

• Clothes wringing motions?<br>

  Yes

  No

  N/A

• Finger pinch grip?<br>

  Yes

  No

  N/A

Industrial Hygiene and Environmental Issues:

• Is the average noise level of the equipment, and in the area, less than 82 dBA (8-hour TWA)?<br>

  Yes

  No

  N/A

• dBA running:

• dBA off:

• Has sufficient lighting been provided so that operation, servicing, maintenance and repair can be carried out safely?<br>

  Yes

  No

  N/A

• Do you suspect the Laser Velocity Gauge (Laser Encoder) increase due to this change?

  Yes

  No

  N/A

• Do you have any engineer or administrative solution to minimize the non-ionizing radiation exposure?

  Yes

  No

  N/A

• Is local exhaust ventilation adequate to control airborne exposure to particles, liquid splashing, vapors, or fumes?<br><br>

  Yes

  No

  N/A

• Is ventilation and climate control in the area sufficient?<br>

  Yes

  No

  N/A

• Do we need to conduct IH monitoring to confirm compliance status after project completion?

  Yes

  No

  N/A

• Have emissions of pollutants to the air been reviewed for regulatory applicability?<br>

  Yes

  No

  N/A

• Have pollution control devices associated with the process been reviewed for regulatory applicability?<br>

  Yes

  No

  N/A

• Is secondary containment associated with the equipment adequate to contain the volume of the largest oil reservoir?<br>

  Yes

  No

  N/A

• Does the equipment avoid the use of CFC or HCFC refrigerants?<br>

  Yes

  No

  N/A

• Does the equipment avoid the use of mercury-containing components (switches, etc.)?<br>

  Yes

  No

  N/A

• Has the chemical review process been completed for new chemicals associated with the process?<br>

  Yes

  No

  N/A

• Is the storage of chemicals associated with the process proper and adequate?<br>

  Yes

  No

  N/A

• List all chemicals associated with the process, used in equipment, or used for maintenance.
  

• Coolants?<br>

  Yes

  No

• List all coolants:

• Cleaners?<br><br>

  Yes

  No

• List all cleaners:

• Solvents?<br>

  Yes

  No

• List all solvents:

• Oils?<br>

  Yes

  No

• List all oils:

• Other:<br>

  Yes

  No

• List other:

• Does the process require the use of fuels?<br>

  Yes

  No

• List all fuels:

• Will the equipment/process generate waste?<br>

  Yes

  No

• List all wastes:

• Equipment Specific Comments

• Select an answer:

  Select The items requiring corrective action have been completed as listed above, and the equipment can be released for production purposes. The equipment does not require corrective action and can be released for production purposes. The equipment is not deemed safe and should not be released for production until all corrective actions are completed.

  • The items requiring corrective action have been completed as listed above, and the equipment can be released for production purposes.
  • The equipment does not require corrective action and can be released for production purposes.
  • The equipment is not deemed safe and should not be released for production until all corrective actions are completed.

• Auditor Signature

  Sign

• Project Champion Signature

  Sign