• Reference number:

  • Asset Tag No:

Section 1 - Suitability

  • 1.1 Does the equipment comply with statutory requirements?

  • 1.2 Is the equipment suitable for the work?

  • 1.3 Has the equipment been modified or adapted?

  • 1.4 Are written manufacturers specifications and instructions available?

  • 1.5 is the equipment accessible to operate without over reaching/over stretching?

  • 1.6 Are highly repetitive tasks eliminated or avoided?

  • 1.7 Can the equipment be used without exerting excessive force?

  • 1.8 Do operating positions, working heights and reach distances accommodate the operator?

  • 1.9 Is the equipment established or secured to prevent hazards from movement?

Section 2 - Maintenance

  • 2.1 What periodic inspection is required?

  • 2.2 Has the equipment been added to the maintenance schedule?

  • 2.3 Is all maintenance restricted to designated competent staff?

  • 2.4 Is all maintenance carried out with equipment stopped?

  • 2.5 Is maintenance carried out in a zone clearly marked to warn staff of the danger?

  • 2.6 Is the equipment subject to a lock and tag out procedure?

  • 2.7 Are pre-use inspection checks carried out?

  • 2.8 Is equipment capable of being isolated from all of its energy sources and supplies by safe clearly identifiable means?

  • 2.9 Can equipment be re-energised without exposing any person to risk from danger that may affect health and safety?

  • 2.10 Is all maintenance carried out subject to equipment isolation?

Section 3 - Restrictions

  • 3.1 Is the equipment restricted to nominated staff whose duties require them to use it?

  • 3.2 Is training available in the safety requirements for all staff who use or manage the equipment?

  • 3.3 Can the equipment be secured from inappropriate use by untrained staff?

Section 4 - Environment

  • 4.1 Is sufficient lighting provided to illuminate the working area?

  • 4.2 Is illumination sufficient to prevent hazards arising from poor visibility when the equipment is in use?

  • 4.3 Is sufficient space available to operate around the equipment without risk to health or safety?

Section 5 - Guarding

  • 5.1 Are all dangerous parts of the equipment guarded or interlocked?

  • 5.2 Where guarding cannot be used are other protective devices or protocols implemented?

  • 5.3 Where protection cannot be provided in 5.1 or 5.2, are risks adequately controlled by provision of information, instruction, training and supervision?

Section 6 - Specific Hazards

  • 6.1 Are risks from specific hazards controlled and reduced ALARP by means other than PPE?

  • 6.2 Have you prevented articles or substance falling or ejecting from equipment?

  • 6.3 Have you considered hazards and risks from rupture or disintegration of the equipment?

  • 6.4 Have you considered the risks from fire or overheating?

  • 6.5 have you considered the risk from unintended discharge of any article, gas, dust, liquid, vapour or other substance?

  • 6.6 Have you considered the risk of explosion, ATEX, DSEAR?

Section 7 - Effects of temperature High/Low

  • 7.1 Are all hot/cold parts of the equipment likely to cause harm or injury protected?

  • 7.2 Are all hot/cold substances or article associated with the equipment protected?

  • 7.3 Are hot/cold parts of equipment clearly marked with warning signs?

Section 8 - Controls

  • 8.1 Is the control system designed to reduce the risk to operators or equipment safety?

  • 8.2 Is the equipment provided with clearly marked start, stop or level controls, are visible and clearly marked?

  • 8.3 Are controls designed to require a deliberate action to operate them?

  • 8.4 Are all controls outside any danger zone?

  • 8.5 Are controls positioned to prevent any inadvertent operation?

  • 8.6 Are controls shrouded or have a lock off facility?

  • 8.7 Do control operators have a full and clear view of the equipment?

  • 8.8 Is the equipment fitted with a clearly marked emergency stop in the event of a hazard occurring?

  • 8.9 Are automatic sensor devices fitted to the equipment to switch it off in event of a hazard occurring?

  • 8.10 Are audible or visible warning lights fitted to the equipment linked to Start, Stop or Danger sensors?

  • 8.11 Is the control system designed to fail safe in the event of power loss or machine instability?

  • 8.12 Are lock off and permit to work systems in place where appropriate?

  • 8.13 Is the operation of the equipment carried out under a safe system of work or procedure document?

  • Action plan

  • Print name and Sign

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.