PM Task Template

PM Task Preliminary Safety Checklist

• When equipment is down, perform proper LOTO procedure in accordance with CBP requirements.

• These instructions are to include establishing 'ZERO ENERGY STATE' before starting PM tasks. Zero energy state requires shutting off and draining all stored energy from air, hydraulic fluid, coolant, vacuum, or electrical energy, and testing the machine before beginning work. Please provide description and location of those energy sources you secure before beginning work. Refer to SDS for proper PPE on chemicals being used in or around equipment.

• While equipment is operating, communicate with operator that you are in the area and are performing inspection tasks. Ensure all guards are in place and operational.

• Adhere to ALL Safety signage and warnings. Refer to SDS for proper PPE on chemicals being used in or around the equipment.

• Pass
• Flag
• Fail

• Pass
• Flag
• Fail

• Pass
• Flag
• Fail

• Pass
• Flag
• Fail

• Pass
• Flag
• Fail

Post PM Task Safety Checklist

• Check the electrical disconnect switch for proper operation (if applicable)

• Check the disconnect switch for proper lock out capabilities (if applicable)

• Check all light curtains for proper operation (if applicable)

• Check all finger switches for proper operation (if applicable)

• Check all door interlocks for proper operation (if applicable)

• Check all e-stops for proper operation (if applicable)

• Check all machine (cell) enclosures for proper placement (if applicable)

Return equipment back to operation checklist.

This checklist must be completed prior to releasing the equipment back to production and operations.

• Ensure all tools are clear of work area.

• Ensure all machine guards are in place and in good condition.

• Verify all personnel are clear of work area.

• Remove LOTO devices and re-energize equipment.

• Communicate to the production leadership of any changes or settings made during the inspection and coordinate to establish requirements for system startup.

• Observe equipment for proper operation.

For PM process improvement, please provide any additional information about this machine that represents normal operation conditions.

These may include such items as: Pressures, Operating Temperature, Control Set-points, Dimension, etc. List any items needed to complete the PM task.

Tools required:

WO# for Corrective work order created because of this task:

WO Description:

Are we doing this PM too often?

• Yes
• No
• N / A

Is the equipment number visible and in good condition?

• Yes
• No
• N / A

When complete, sign and date the Work Order in the appropriate area.