PowerTools

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.
  
  Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

• Critical Controls

• Have you completed a Team Risk Assessment prior to starting the job?

  Controlled

  At Risk

  N/A

• The guards protect from moving parts, rotating equipment, pinch points, line of fire, or guarded by location

  Controlled

  At Risk

  N/A

• The tool has not been altered

  Controlled

  At Risk

  N/A

• The annual ground check has been completed, if equipped with a grounding plug

  Controlled

  At Risk

  N/A

• Employee understands which emergency stop devices are on the equipment, how they function, and how to activate the emergency stop function

  Controlled

  At Risk

  N/A

• Employee is dressed in clothing that is not loose fitting and long hair is tied back or protected

  Controlled

  At Risk

  N/A

Assessment

• CONTROLLED The presence of this control is verified and effective

• AT RISK This control is missing or ineffective

• NA / NO Not Applicable to this exposure situation or Not Observed