Title Page
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Document No.
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Facility Location
- American Tube
- Atlas Tube - Blytheville
- Atlas Tube - Chicago
- Atlas Tube - Harrow
- Atlas Tube - Plymouth
- Atlas Tube - Oak Bluff
- Picoma - Cambridge
- Sharon Tube - Niles
- Wheatland Tube - Chicago
- Wheatland Tube - Council Ave
- Wheatland Tube - Warren
- Western Tube
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Conducted on
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Audit performed by:
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Safety Device Audit
Device
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Device id#
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Location of the Device (location, machine, column number, area, etc)
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Take a picture of the device being audited
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Type of device being audited (multiple choice)
- Area Scanner
- Door/Gate safety switch
- Light Curtain
- Keyed Interlock (Kirk Key, etc)
- Conveyor Sensors (Ring of Fire, etc)
- Emergency Stop
- Photo Eye Switch
- Industrial Safety Mat
- Request to Enter Switch
- Dual hand/finger Control
- Other
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Is the device accounted for in the "Safety Device Inventory" for this location?
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What is purpose/function of the device? (ie: the saw stops when the door is opened)
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Does the device operate or function at intended? (Add notes for NO or N/A selections)
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Comments (ie: more suitable device required, control not effective, etc)
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Auditor's Name & Signature
