[UNIT NAME] MACHINE GUARDING AND SAFETY
ASSESSMENT SELF-INSPECTION CHECKLIST
This form is intended for the shop safety coordinator (or designee) to complete for each
machine/equipment initially and after modification. Environmental Health & Safety (EH&S) recommends
completing this form for older equipment in use prior to a shop safety inspection. This form can be
completed for typical shop equipment such as band saws, table saws, drill presses, laser cutters, lathes,
milling machines, and CNCs. For questions about this checklist contact the EH&S Shop and Maker Space
Safety Program at (206) 543-7388; ehsshop@uw.edu.
Person conducting inspection: _____________________________ Date: ______________
Unit or department: ______________________________________________________________
Shop safety coordinator: __________________________________________________________
Building: _____________________________ Room: _______________________________
Equipment type/name: ____________________________________________________________
Manufacturer: ______________ Model #: ____________ Serial #: ____________
New Equipment: Yes / No Retrofitted Equipment: Yes / No
Asset Tag #: ______________ Equipment #: ______________
Instructions: Place a check in the “Yes” column for acceptable conditions. Place a check in the “No”
column for conditions that need to be addressed. Place a check in the “N/A” column for items that do not
apply. Address any No checkmarks by documenting why not and writing corrective actions taken in the
Corrective Action section. If safeguarding devices, distance, or PPE are used instead of a guard, provide a
description in the column “If No, explain why.”
Requirements for all machines or equipment
# Yes No N/A ITEM If No, explain why.
Are point-of-operation guards or other safeguarding provided for
any of the following: guillotine cutters, shears, alligator shears,
1
power presses, milling machines, power saws, jointers, portable
power tools, or forming rollers?
2 Are all belts or chain drives fully enclosed by guards?
Are all gears, sprockets, pulleys, or flywheels fully enclosed by
3
guards?
Are all rotating set screws, keyways, or collars fully enclosed by
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guards?
Are all rotating parts, reciprocating or transverse motions fully
5
enclosed by guards?
Are all pinch point hazards fully guarded for the entire length of the
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pinch point?
Are all openings to danger-areas of ¼ inch or greater size properly
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guarded?
Do all machine safeguards prevent workers’ hands, arms, and other
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body parts from contacting dangerous moving parts?
Machine Guarding and Safety Assessment Self-Inspection Checklist| www.ehs.washington.edu | April 2024| Page 1 of 4
# Yes No N/A ITEM If No, explain why.
Are the safeguards firmly secured to the machine and not easily
9
removable?
Are all safeguards tamper-resistant and difficult to accidentally
10 remove or bypass? If no, provide the evidence that the safeguards
have been tampered with or removed/by-passed.
Are existing safeguards adequate to keep safe all personnel from
11 hazards associated with normal machine operation and possible
malfunction?
Do the safeguards permit safe, comfortable, and relatively easy
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operation of the machine?
Are the guards free of hazardous projections, unfinished surfaces,
13 weld splatter, sheared-exposed edges, or other types of sharp
edge?
Do the safeguards ensure that no objects will fall into the moving
14
parts?
Can the machine be lubricated without removing the safeguard?
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(No may be acceptable depending on age/style of equipment)
Are there warning labels, color-coding, or markings to show
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hazardous areas?
Do the safeguards provided meet the minimum WAC 296-806
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Machine Safety requirements?
Is there a system for shutting down the machinery before
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safeguards are removed?
Are the existing safeguards effective and do not require be
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improvements?
Has the machine been evaluated to determine if changes can be
20
made to eliminate the point-of-operation hazard entirely?
Machine controls
# Y N N/A ITEM If No, Indicate why not
Are all starting and stopping controls within easy reach of the
21
operator?
Have separate controls been provided for equipment designed for use
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by more than one operator?
Are foot-operated controls located or guarded to prevent
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unintentional activation?
24 Do all machines not automatically restart after a power failure?
Do all machines have Emergency stops (E-stops) controls that are red
in color, easily reached from the operator’s normal position, in good
25
working condition and must be manually reset before a machine can
be restarted?
Will this machine “fail safe” if the emergency stop is activated or if
26
one or more utilities are impeded or removed?
27 Have all interlock systems functionality been verified and tested?
28 Warning lights and alarms functional?
Machine Guarding and Safety Assessment Self-Inspection Checklist| www.ehs.washington.edu | April 2024| Page 2 of 4
Electrical hazards
# Y N N/A ITEM If No, Indicate why not
Is the machine installed in accordance with National Fire Protection
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Association and National Electrical Code requirements?
Are all electric plugs three-prong with a ground, and plugged into a
30
grounded outlet?
Are all conduit fittings tight and appear to be in good repair and
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undamaged?
All equipment, where required, has been designed to accept and
32 OSHA approved locking device and tag when service or repair is
required?
Is there an equipment specific LOTO procedure for shutting down the
33 machinery and locking / tagging it out before safeguards are removed,
where required?
Other requirements for machine safety
# Y N N/A ITEM If No, Indicate why not
Is the machine seismically restrained, if required or secured and will
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not move or change position during operation?
Have appropriate measures been taken to safeguard workers against
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noise hazards?
Have special guards, enclosures, local exhaust ventilation, filtration, or
personal protective equipment been provided, were necessary, to
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protect workers from exposure to harmful substances used in
machine operation?
Is there adequate placement, accessibility, and ergonomic
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positioning?
38 Are accessible surfaces smooth and free of sharp edges?
39 Is the area cleaned from debris?
40 Is there adequate illumination?
41 Has excess vibration eliminated?
42 Are hazard warnings required are in place?
Corrective actions
Instructions: Describe corrective action(s) below for all items marked “No” above. Indicate the item
number and date completed for each item. Describe interim actions if the corrective action is not yet
complete (e.g., “locked and tagged out equipment”). If modifications to the equipment or machine is
required, complete the section below.
Click or tap here to enter text.
Machine Guarding and Safety Assessment Self-Inspection Checklist| www.ehs.washington.edu | April 2024| Page 3 of 4
Modifications Required? Yes / No
Follow-up date: ______________ Modification completion date: ______________
REVIEW
Reviewer's signature below verifies personal review and approval of the aforementioned equipment for
potential safety deficiencies and modifications required. EH&S review is required when modifications
are made to the equipment electrical components (on/off buttons, selector switches, interlocks, E-stops,
wiring, etc.)
REVIEWERS PRINTED NAME SIGNATURE INITIALS DATE
Shop Safety Coordinator
Principal
Investigator/Manager, Shop
Environmental Health &
Safety (review only)
OTHERS (as required):
Machine Guarding and Safety Assessment Self-Inspection Checklist| www.ehs.washington.edu | April 2024| Page 4 of 4
