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?

Maintenance

  • 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?

Controls

  • 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?

Isolations

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

Stability

  • Is the equipment securely mounted and stable?

Lighting

  • 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)?

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.