Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

Document Revision

    Revision
  • Date of Revision

  • Who revised the document

  • Details of Revision

Contacts

  • Site Contacts

  • Details of Contact
  • Name

  • Title

  • Phone Number

  • E-Mail

Identification of Machine

  • Make / Model / Identification evidence of machine

  • Photo

  • Use

Guarding

  • Are Light Curtains, Laser Scanners or ESPE of any type being used as machine guarding?

  • Is there current mechanical guarding in place on machinery?

  • Is guarding ZERO ACCESS i.e. sufficient to prevent access to the moving parts?

  • Describe what additional controls are in place, if any?

  • Are the gaps adequate to prevent accidental access to dangerous moving parts?

  • Describe what additional controls are in place, if any?

  • Are there any unguarded nip points?

  • Describe what additional controls are in place, if any?

  • Is a specialist tool required to remove existing guarding?

  • Is the tool stored away from machinery?

  • Is there a permit system in place prior to the removal of guarding?

  • Are all electrical fixtures covered?

  • Is there a need for integrated guarding (eg two handed operation due to exposed dangerous components while in use)?

  • Describe what complementary safety controls are in place?

  • Are AS6157 compliant walkways,platforms and guard rails used to prevent access to dangerous parts?

  • Details of possible improvements according to AS6157.

  • Is there suitable access for servicing eg removable section to service, maintenance, removable panels to allow access to adjust bolts etc?

  • Are guards secured eg mounting bolts tightened, grills secured?

  • Are safety isolation lock out devices (LOTO) fitted and tested as operational?

Findings

Additional Information and comments

Recommendations

Auditee

  • Add signature

Validation of Safety Related Parts of Control System (SRPCS)

SRPCS Validtaion

  • What type of controls are used on this machinery?

  • Have all reasonable measures been taken to place the Safety Devices far enough away from the hazards to ensure machine comes to a stop before reaching the hazard? See standards such as AS4024:2801 for guidance

  • Please detail your assumptions and how what you have done is equal to or better than the current state of knowledge - i.e. AS4024:2801

Validation Testing - Fault Analysis of SRPCS Devices Used

  • Emergency Stops & Lanyard Switches

  • Validation Test Results

  • Details of failure and remedial action required.

  • Interlocks (RFID, Magnetic, Mechanical and Solenoid Locking)

  • Validation Test Results

  • Details of failure and remedial action required.

  • Light Curtains, Grids, Scanners, Cameras and Single beam Switches

  • Validation Test Results

  • Details of failure and remedial action required.

  • Is Muting of Light Curtains Used?

  • Muting of Light Curtains, Grids & Scanners

  • Validation Test Results

  • Details of failure and remedial action required.

  • RESET Circuit Testing and Testing of Safety Contactor Feedback

  • Validation Testing Results

  • Details of Failure and remedial action proposed.

  • Validation of Safety Software - Configurable Relays and Safety PLCs - refer to AS4024.1503:2014 & AS62061:2005

  • Safety Relay Types Used

  • Validation Test Results

  • Validation Test Results

  • Details of failure and remedial action required.

  • Complementary Safety Measures Used?

  • Validation Testing Results

  • Details of Solutions and Testing i.e EN574 for Two Hand Controls.

Additional Information

  • Additional Information - any specific solutions not considered by this validation

  • Person Completing Report

  • Select date

  • Add signature

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.