Machine Safety Equipment Audit Form_2021

  • Machine Safety Equipment Audit Form

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  • Please answer the following questions by choosing (✓) one option only. Click again to deselect the option. 

    • Please refer back to Question 1a and choose the appropriate option. 

  • Please Click to understand the right dangerous hazard: 

  • Abrasion

    X

    Abrasion

    Occurs as a result of bodily contact with relatively smooth parts operating at high speeds or abrasive hazards (e.g., abrasive wheels or belt sanders). 

  • Crush

    X

    Crush

    Occurs as a result of bodily contact between one part of machinery moving against another part. This could also include falling objects.

     

  • Cutting

    X

    Cutting

    Cutting occurs as a result of bodily contact with such items as cutting tools, saws,

    routers, knives, or moving sheet metal.

  • Electrical

    X

    Electrical

    Occurs as a result of bodily contact with an electrical energy source. 

  • Entanglement

    X

    Entanglement

    Drawing-in occurs as a result of bodily contact with one of the following mechanisms:
    i) in-running nips between two counter-rotating parts; and
    ii) in-running nips between a rotating surface and a tangentially moving surface.

     

  • Impact

    X

    Impact

    Occurs as a result of bodily contact with objects acting against the inertia of the body but not penetrating it. This could also include falling objects. 

  • Shear

    X

    Shear

    Parts of the body can be sheared between two machine parts or between a machine part and a workpiece.

     

  • Thermal

    X

    Thermal

    Occurs as a result of bodily contact with a heat source.

  • Fumes

    X

    Fumes

    Occurs as a result of inhalation of chemical hazards. 

  • Trip

    X

    Trips

    Coming into contact with an item on the floor causing an operator to lose their balance. 

    • Please refer back to Question 2a and choose the appropriate option.

  • Please Click to understand the right dangerous hazard: 

  • Abrasion 

    X

    Abrasion

    Occurs as a result of bodily contact with relatively smooth parts operating at high speeds or abrasive hazards (e.g., abrasive wheels or belt sanders).

     

  • Crush

    X

    Crush

    Occurs as a result of bodily contact between one part of machinery moving against another part. This could also include falling
    objects.

     

  • Cutting

    X

    Cutting

    Cutting occurs as a result of bodily contact with such items as cutting tools, saws, routers, knives, or moving sheet metal.

     

  • Electrical

    X

    Electrical

    Occurs as a result of bodily contact with an electrical energy source.

     

  • Entanglement

    X

    Entanglement

    Drawing-in occurs as a result of bodily contact with one of the following mechanisms:


    i) in-running nips between two counter-rotating parts; and
    ii) in-running nips between a rotating surface and a tangentially moving surface.

     

  • Impact

    X

    Impact

      Occurs as a result of bodily contact with objects acting against the inertia of the body but not penetrating it. This could also include falling objects.

     

  • Shear

    X

    Shear

    Parts of the body can be sheared between two machine parts or between a machine part and a workpiece.

     

  • Thermal

    X

    Thermal

    Occurs as a result of bodily contact with a heat source.

     

  • Fumes

    X

    Fumes

    Occurs as a result of inhalation of chemical hazards.

     

  • Trip

    X

    Trips

    Coming into contact with an item on the floor causing an operator to lose their balance.

     

    • Please refer back to Question 3a and choose the appropriate option.

  • Please Click to understand the right dangerous hazard: 

  • Abrasion 

    X

    Abrasion

    Occurs as a result of bodily contact with relatively smooth parts operating at high speeds or abrasive hazards (e.g., abrasive wheels or belt sanders).

     

  • Crush

    X

    Crush

    Occurs as a result of bodily contact between one part of machinery moving against another part. This could also include falling
    objects.

     

  • Cutting

    X

    Cutting

    Cutting occurs as a result of bodily contact with such items as cutting tools, saws, routers, knives, or moving sheet metal.

     

  • Electrical

    X

    Electrical

    Occurs as a result of bodily contact with an electrical energy source.

     

  • Entanglement

    X

    Entanglement

    Drawing-in occurs as a result of bodily contact with one of the following mechanisms:


    i) in-running nips between two counter-rotating parts; and
    ii) in-running nips between a rotating surface and a tangentially moving surface.

     

  • Impact

    X

    Impact

      Occurs as a result of bodily contact with objects acting against the inertia of the body but not penetrating it. This could also include falling objects.

     

  • Shear

    X

    Shear

    Parts of the body can be sheared between two machine parts or between a machine part and a workpiece.

     

  • Thermal

    X

    Thermal

    Occurs as a result of bodily contact with a heat source.

     

  • Fumes

    X

    Fumes

    Occurs as a result of inhalation of chemical hazards.

     

  • Trip

    X

    Trips

    Coming into contact with an item on the floor causing an operator to lose their balance.

     

    • Please choose the right options in Question 1a, Question 2a, and Question 3a to submit the form.
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