Title Page

  • Site conducted

  • Conducted on

  • Location
  • Assessor Name

  • Equipment

  • Area

Suitability of Work Equipment

  • Is the equipment suitable for it's intended purpose?

  • Does the equipment location pose a risk to health and safety of persons?


  • Is the procedure and frequency of maintenance (jobs) entered in the TPM

  • Is the equipment inspected for any deterioration that may result in risks to personnel?

  • Where fitted, are the safety and protection devices periodically tested and recorded?

  • Is the maintenance history available?

Specific Risks

  • If this is "Specific Risk Equipment", are there measures in place to ensure that only authorized/trained personnel use/maintain the equipment?

Information & Instruction

  • 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

  • Is the equipment CE marked?

Dangerous Parts of Machinery

  • Are the "Dangerous Parts" of this equipment suitably guarded?

  • Is it possible to bypass any guards or protective devices without the need for a tool?

  • Where guards are not fitted, are suitable risk reduction measures in place to control danger to personnel?

Protection Against Specific Hazards

  • 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

  • Are there parts of the equipment that could cause a burn, scald or sear protected?


  • Are the controls for starting, stopping and controlling the equipment clearly identifiable and safe to use?

  • Is it likely the controls could be inadvertently, accidentally or self activated?

  • Are combined stop and start controls designed so that the stop function has priority following release of the control?

  • Is the stop control easy to use and will its activation bring the equipment to a safe condition in a safe manner?

  • Where fitted confirm that the Emergency Stop is readily accessible and NOT combined with the Stop control.

  • 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?


  • Is it possible to safely isolate the equipment's energy supplies?


  • Is the equipment securely mounted and stable?


  • Is the local lighting sufficient?

Maintenance Operations

  • Can maintenance be performed without risk to persons (using appropriate measures)?

  • 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

  • Is the equipment appropriately marked for reasons of health and safety, and so that the equipment can't be confused with similar equipment?

  • Are any warning signs or warning signals for the reasons of health and safety clearly visible/audible?

Mobile Work Equipment

  • Is the equipment suitable for carrying persons safely?

  • Is the operator protected by roll over protection?

Lifting Equipment

  • Is the equipment used for lifting and subject to independent inspection (LOLER)?

Sign Off

  • Name and signature of assessor

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