Title Page
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Site conducted
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Conducted on
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Location
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Assessor Name
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Equipment
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Area
Suitability of Work Equipment
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Is the equipment suitable for it's intended purpose?
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Does the equipment location pose a risk to health and safety of persons?
Maintenance
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Is the procedure and frequency of maintenance (jobs) entered in the TPM
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Is the equipment inspected for any deterioration that may result in risks to personnel?
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Where fitted, are the safety and protection devices periodically tested and recorded?
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Is the maintenance history available?
Specific Risks
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If this is "Specific Risk Equipment", are there measures in place to ensure that only authorized/trained personnel use/maintain the equipment?
Information & Instruction
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Do you consider all relevant health and safety information, and where required written instructions have been made available at the work site?
Conformity with Community Requirements
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Is the equipment CE marked?
Dangerous Parts of Machinery
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Are the "Dangerous Parts" of this equipment suitably guarded?
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Is it possible to bypass any guards or protective devices without the need for a tool?
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Where guards are not fitted, are suitable risk reduction measures in place to control danger to personnel?
Protection Against Specific Hazards
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Is there any reasonable probability of any article or substance being ejected, falling, rupturing, breaking, being thrown out, disintegrating, catching fire, overheating or exploding?
High or Very Low Temperature
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Are there parts of the equipment that could cause a burn, scald or sear protected?
Controls
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Are the controls for starting, stopping and controlling the equipment clearly identifiable and safe to use?
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Is it likely the controls could be inadvertently, accidentally or self activated?
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Are combined stop and start controls designed so that the stop function has priority following release of the control?
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Is the stop control easy to use and will its activation bring the equipment to a safe condition in a safe manner?
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Where fitted confirm that the Emergency Stop is readily accessible and NOT combined with the Stop control.
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Would any failure of a control system result in a "fail safe" condition which would not impede the operation of the Stop or Emergency Stop Controls?
Isolations
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Is it possible to safely isolate the equipment's energy supplies?
Stability
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Is the equipment securely mounted and stable?
Lighting
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Is the local lighting sufficient?
Maintenance Operations
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Can maintenance be performed without risk to persons (using appropriate measures)?
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Are there likely to be any hazardous substances generated by the equipment or equipment near by that may cause harm whilst performing maintenance?
Markings & Warnings
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Is the equipment appropriately marked for reasons of health and safety, and so that the equipment can't be confused with similar equipment?
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Are any warning signs or warning signals for the reasons of health and safety clearly visible/audible?
Mobile Work Equipment
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Is the equipment suitable for carrying persons safely?
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Is the operator protected by roll over protection?
Lifting Equipment
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Is the equipment used for lifting and subject to independent inspection (LOLER)?
Sign Off
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Name and signature of assessor