Conducted on
Date
Prepared by
Location
Address
I POINT OF OPERATION
1. All energy sources are known.
Implementation: Full
Implementation: Partial
Implementation: No
2. LOTO points are clearly labeled.
Implementation: Full
Implementation: Partial
Implementation: No
3. Machines have 360 guarding around the point of operation.
Implementation: Full
Implementation: Partial
Implementation: No
4. Guards are interlocked to power source to prevent use when guard is removed.
Implementation: Full
Implementation: Partial
Implementation: No
5. Work instructions are accessible and understood.
Implementation: Full
Implementation: Partial
Implementation: No
6. Engineering controls are protecting the employee while inside the guards and exposed to the danger zone.
Implementation: Full
Implementation: Partial
Implementation: No
II TRAINING & QUALIFICATION
1. Operators are qualified to perform work.
Implementation: Full
Implementation: Partial
Implementation: No
2. Employees are fully aware of the hazards (Safety & Environment) and controls to protect against injury.
Implementation: Full
Implementation: Partial
Implementation: No
3. Set up and Changeover instructions are accessible and well understood.
Implementation: Full
Implementation: Partial
Implementation: No
4. There is a process to on-board new employees in the work areas.
Implementation: Full
Implementation: Partial
Implementation: No
5. People are trained to respond to an emergency within the work area and annual drills are performed.
Implementation: Full
Implementation: Partial
Implementation: No
III WORK AREA
1. Slip, trip and fall hazards are identified and controlled.
Implementation: Full
Implementation: Partial
Implementation: No
2. PPE signs are visible and worn by all users in the area.
Implementation: Full
Implementation: Partial
Implementation: No
3. WIP or Raw Stock and finish goods are in designated locations.
Implementation: Full
Implementation: Partial
Implementation: No
4. Ergo lifting rules are understood, followed and enforced.
Implementation: Full
Implementation: Partial
Implementation: No
IV. MAINTENANCE
1. Operators conduct a daily inspection of equipment and report <br>any concerns.
Implementation: Full
Implementation: Partial
Implementation: No
2. Preventative maintenance inspections are conducted.
Implementation: Full
Implementation: Partial
Implementation: No
3. There is a process to protect Maintenance Technicians from performing energized work (Only energized testing is permitted in Schneider Electric).
Implementation: Full
Implementation: Partial
Implementation: No
* Follow Machine specific LOTO procedures before starting work.
Implementation: Full
Implementation: Partial
Implementation: No
V. CONTINUOUS IMPROVEMENT
1. Hand tools and lift assists are used to prevent injury.
Implementation: Full
Implementation: Partial
Implementation: No
2. 5’S principles visible, aisles are clearly labeled and PIT’s are minimized and restricted from area.
Implementation: Full
Implementation: Partial
Implementation: No
3. Employees are proactive to report malfunctions, near miss, safety ideas and safety observations.
Implementation: Full
Implementation: Partial
Implementation: No
link copied
Joanna Perkowska
Schneider Electric SERE Workplace Assessment for Machines and Rotating Shafts
Assessment Report
#wecare
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.
