Title Page

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Date

  • Job Number

Equipment Checklist

  • Has the correct power and amperage been verified before hook up of machine to the power source?

  • Have vacuum hoses been inspected for damage and installed correctly?

  • Has Machine been checked for loose bolts, nuts, plates, and diamonds?

  • Are all electrical plugs and sockets hooked up and in the locked position?

  • Add picture of electrical plug hook up

  • Are the start stop switches in working order and have been tested?

  • Have inspections of machine taken place per manufactures recommendations?

  • Is the Handle locking device in working order?

  • Are dust shrouds in place and in working order?

Safety Checklist Floors Grinding Machines

  • Have all users been properly trained on use of machine by an Authorized person?

  • Are all users wearing safety glasses?

  • Are all users wearing hearing protection?

  • Are all users wearing proper safety shoes?

  • Are all users wearing respirator protection? Half face mask minimum

  • Users must tie back loose hair and not wear loose clothing or jewelry including rings to prevent getting caught in moving parts

  • Are cords and vacuum hoses used in a way to prevent slips, trips and falls?

  • Has machine been visually checked for damage and defects?

  • Has work area been checked for debris? (Floor bolts, loose material that could fly out of machine)

  • Has a Controlled Access Zone been established around the work area?

  • Have electrical cables been checked for correct size and voltage?

  • Have Electrical cable plugs and sockets been check for loose fit, socket prongs tight and not broken, no exposed wiring?

  • Has Emergency stop button been tested and in working order?

Safety Checklist Hand Grinders and Floor tools

  • Are users wearing proper PPE? Safety Glasses, Face Shields, Hard hat, gloves and respirator?

  • Users must tie back loose hair and not wear loose clothing or jewelry including rings to prevent getting caught in moving parts

  • Have all power cords been inspected and have no damage to insulation, all socket prongs intact and no exposed wiring? Are GFCI's being used on all extension cords?

  • Are dust shrouds attached, visually inspected for damage and in working condition?

  • Have all blades or grinding wheels been inspected for defects, damage and are the correct speed rating for the tool?

  • Have Hand grinder/edgers been visually inspected, guards in place, blades/wheels tightened and handles secured?

  • Are floor creepers present and being used per company policy? 1. See ergonomic policy below for compliance

  • Have vacuums been inspected, filters checked and in working condition?

Ergonomics Plan

  • Racatac Floor Creepers- The following policy is mandatory for all use of hand grinders. Racatac creepers will be used at all times during hand grinding operations.
    1. No longer than 1 hour per user
    2. Switch between crew members
    3. If you start to feel fatigued or pain before the 1 hour tell your foreman and switch out with another crew member

  • When mounting RACATAC,
    1. Stand behind and over the seat
    2. Slowly bend both knees directly into corresponding kneepads then sit Be sure that you keep your weight directly on the RACATAC Leaning too much forward, sideward or backward may cause lifting or tilting.
    3.While on two knees, you may use your feet and toes to maneuver.
    4.Always make sure your work area is clean and free of debris before working with the RACATAC creeper

  • 1. List Below the crew members who will be using the hand grinders and the time schedule for each member Example: John Smith 8am-9am Jose Garcia 9am-10am

  • Foreman/Crew Leader Signature By signing below you are confirming compliance with the above Ergonomic Plan

Substrate Conditions and Prep

  • Relative Humidity of Air

  • Air Temperature

  • Substrate moisture reading

  • Estimated square feet of production today

  • Type of work being done today

  • Lot/Batch number for products being used

  • Measured CSP reading

Crew responsibilities

  • Mixer

  • Applicators

  • Back Rollers

Hours reporting

  • Total job hours

  • Total job hours remaining at the start of the Day

  • Total estimated hours going to be used today

  • Total hours remaining at the end of the day

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.