Title Page

  • Client / Facility

  • Conducted on

  • Prepared by

  • Location

PSSR

Information

  • Equipment/Facility

  • Equipment name

  • Location of Equipment

  • Facility name

  • PSSR Team Members

Lockout/Tagout

  • Is the machine capable of being locked out?

  • Has the equipment specific lockout/tag out procedure been developed?

  • Are there any special lockout devices needed?

  • Have they been ordered and distributed to the appropriate personnel?

  • Have sanitation, production, and maintenance employees been properly trained on the lockout procedures?

Mechanical Hazards

  • Are equipment disconnects and operating controls labeled?

  • Are the start and stop controls within easy reach of the operator?

  • Is there plant maintenance for the equipment?

  • Are maintenance personnel trained to perform the plant maintenance?

  • Can the machine be oiled without removing the safeguards?

  • Is there more than one operator?

  • Are separate controls provided?

  • Are Emergency Stops working and accessible to the operator?

Machine Guarding

  • Have all pinch points and points of operation been properly guarded?

  • Have all chains and sprockets been properly guarded?

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

  • Have all pulleys and belts been properly guarded?

  • Have augers (if present) been properly guarded?

  • Are all machine guards securely attached?

  • Are interlocks prohibited from being bypassed if applicable?

  • Test all interlocks to ensure functioning properly if applicable?

  • For saw blades, is only the length necessary to cut product exposed?

  • Are all shafts ends covered with a non-rotating cap or cut down to a length of less than 1/2 the diameter of the shaft?

Electrical

  • Is the machine wired according to code? (National Electric Code, National Fire Protection Association)

  • Is the machine grounded?

  • Is the power supply correctly fused and protected?

  • Will additions or modifications require an Arc Flash analysis?

  • Are all electrical connections secured, cords only the length necessary, conduit only used where required (no cords running through walls, under doors, etc)?

  • Is there any temporary equipment S/O cord (allowed for only 90 days) if any follow up required?

Personal Protective Equipment (PPE)

  • Has PPE Hazard Analysis been conducted for new jobs?

  • Is required PPE available and issued to operators?

  • Have operators been properly trained in the use and care of required PPE?

Noise

  • Have appropriate measures been taken to safeguard workers against noise hazards?

  • Has an area survey been conducted?

  • If noise is above 85 dB, has noise reduction measures been considered?

Evacuation/Egress

  • Have existing means of egress been obstructed or changed (at least 28")?

  • Have exit routes been rerouted if necessary?

  • Have employees been trained in new exit routes?

  • Has the emergency evacuation drawing been updated?

  • Is head room at least 7 feet high with no overhead obstructions below 6'8"?

  • Have all emergency exits been designated by appropriate signage/lighting?

  • Are new sprinkler systems operational and tested?

  • Fire Extinguisher accessible and adequately marked?

Ventilation

  • Does the new equipment generate hazardous vapors/gasses/fumes which will require additional ventilation?

  • Has ventilation been installed?

  • If ventilation has not been installed, have employees been instructed in temporary hazard abatement procedures?

Ergonomics

  • Has an ergonomic audit (ergonomic job measurement system, ergonomic assessment) been conducted of the new/modified equipment?

  • Have identified ergonomic hazards been corrected?

Confined Spaces & Hazardous Locations

  • Has the new equipment created a hazardous location?

  • What is the nature of the hazard?

  • Identify hazard

  • Permit required for confined spaces?

  • Are all hatches and other means of entry labeled as confined spaces?

  • Have space specific entry procedures been developed?

  • Have employees been trained on entry procedures?

Fall Protection

  • The new equipment will not create a situation in which employees must work more than 4' above the floor and outside of a standard guard rail?

  • Has appropriate fall protection equipment been provided to employees?

  • Have employees been trained in the use of required fall protection equipment?

  • No slip/trip/fall hazards created?

Hazard Communication

  • The new equipment has not introduced any new hazardous chemicals into the facility?

  • Have employees been trained in the hazards and protective measures for the new chemical?

Training

  • Does the new/modified equipment require additional process training?

  • Has the training been conducted?

  • Have new training requirements forwarded to the Training Department?

Food Safety

  • Is the new equipment designed and manufactured to be easily cleaned?

  • Is there a standard operating procedure in place to break down the equipment for cleaning?

  • Has USDA been notified of the addition and the start up of the equipment?

  • Has the cleaning contractor been notified of the addition and the startup date of the equipment?

Air Permits

  • Has equipment received the necessary air permits?

  • Has the regulatory agency been notified of start up?

  • Has a standard operating procedure been modified or created to control the equipment per regulations?

  • Has an updated standard operating procedure been submitted to regulators for approval?

  • Does the facility have spare/redundant critical equipment to keep equipment running within compliance standards?

Wastewater Compliance

  • Has the equipment received the necessary wastewater permits and/or notifications?

  • Has a standard operating procedure been modified/created to control the equipment to not impact wastewater?

  • Is wastewater treatment operations prepared to handle the impact of this process change?

SPCC/Storm water

  • Are secondary containment and/or storm water controls in place?

  • Has the SPCC plan been updated, including site maps?

  • Has a "best management practice" been created for this potential pollution source?

ISO 14001

  • Are the necessary "Operational Controls" established and documented in the environmental management system?

  • Have any new reporting requirements been added to the environmental calendar?

  • Is the process change an Aspect or Significant Aspect?

  • Has the training schedule been updated to include the process change?

Waste/Chemical Notification /Utilities

  • Are the procedures in place to handle the waste (hazardous or non-hazardous) from the process change?

  • Has notification to regulators occurred to address legal requirements?

  • Are appropriate back flow connections installed to prevent contamination of potable water?

  • Are the appropriate mechanical and procedural systems installed to minimize energy/water usage?

Completion

  • Comments/Recommendations

  • Safe and ready for commissioning/startup?

  • Engineering

  • Safety

  • Quality

  • Operations

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.