4 sections, 18 items
1Identification
- Yes / no
Equipment reference, manufacturer, type and serial number confirmed *
- Text
Inspection type (after installation, periodic, after exceptional event) *
- Pass / fail
Operating instructions and previous inspection record available
2Guards and safety devices
- Pass / fail
Fixed guards in place and secure; interlocked guards stop the equipment when opened *
- Pass / fail
Emergency stop devices present, marked and functioning *
- Pass / fail
Light curtains, two-hand controls or other protective devices function
- Pass / fail
Warning signs and markings legible
3Condition
- Pass / fail
Structure, fixings and moving parts free of damage, wear or cracks *
- Pass / fail
Electrical enclosures closed, cables undamaged, no signs of overheating *
- Pass / fail
Hydraulic and pneumatic systems free of leaks
- Pass / fail
Controls labelled, start and stop function as intended *
- Text
Measured values, if any (insulation, noise, pressure)
4Result
- Text
Defects found and their severity
- Photo
Photo of any defect
- Pass / fail
Equipment safe to use until the next inspection *
- Date
Next inspection due *
- Text
Inspector name and qualification (zur Prüfung befähigte Person / competent person) *
- Signature
Inspector signature *
* Required