Plant/Location: |
Department: |
Description: |
(Circle one) New or Modified |
Area Inspection |
|
YES |
NO |
|
YES |
NO |
Slip/Trip/Fall Hazards removed |
|
|
Applicable Warning Signs posted |
|
|
Fire Extinguishers accessible |
|
|
No overhead hazards |
|
|
22" minimum passage clearance |
|
|
Eyewash/shower accessible |
|
|
Adequate area lighting |
|
|
Doors accessible, aisles clear |
|
|
Electric panels accessible |
|
|
Floor drains free of obstructions |
|
|
Ingress/egress clear |
|
|
Housekeeping |
|
|
Equipment Inspection |
|
YES |
NO |
|
YES |
NO |
Adequate guards (all nip-points) |
|
|
Hazards/Warning Signs posted |
|
|
Guards interlocked or secured |
|
|
Interlocks operating effectively |
|
|
Operational check completed |
|
|
Access panels fastened |
|
|
Electrical connections proper |
|
|
Pipe and Hose fittings tight |
|
|
Equipment secured to foundation |
|
|
No sharp edges |
|
|
Controls accessible |
|
|
Controls labeled |
|
|
Indicating lights work |
|
|
Emergency stop properly located |
|
|
Emergency stop works |
|
|
Electrically grounded |
|
|
Insulation of hot/cold surfaces |
|
|
Equipment properly labeled |
|
|
Appears ergonomically designed |
|
|
Floor plan modified |
|
|
Noise levels below 80 dBA |
|
|
NFPA 70E Compliance |
|
|
Administrative Controls |
|
YES |
NO |
|
YES |
NO |
LOTO procedures complete, including troubleshooting |
|
|
Setup and operating instructions complete |
|
|
Planned maintenance identified |
|
|
Confined space procedure updated if applicable |
|
|
IH sampling required and planned for if necessary |
|
|
PPE hazard assessment complete and JHA updated |
|
|
Affected procedures updated |
|
|
Employee training/education complete |
|
|
Ergonomic Hazard Assessment (JHA) completed if necessary |
|
|
MSDS and Training completed |
|
|
Use a blank sheet of paper if more space is needed.
Review Signatures:
The Plant Leader must be the last person to sign off of the checklist. The Plant Leader signature indicates that all changes are approved and the equipment is ready for production use.
