1. ______ Am I qualified and trained to do this PM. If not STOP and get help.

2. _______ Review each step of this PM prior to starting job.

3. ________ Do I have the right tools, equipment, PPE, or permits?

4. ________ Identify what hazard is present for each step of the job

5. ________ Can I control each of those hazards before starting? If not STOP and get Help.

Industrial Sector MESH Document 1.0 General Requirements (Checking) July 17, 2010  Revision

Instrumentation/Controls:

1.01,, Newly installed dials, gauges and switches legibly labeled to indicate function?_____ Yes _____ N/A

Electrical:

2.01,, Motor specifications (horsepower, RPM, volts, amps, etc.) match specifications of motors that were replaced?_____ Yes _____ N/A

2.02,, Over current protection devices such as breakers and fuses match specifications of devices that were replaced?_____ Yes _____ N/A

2.03,, Live parts enclosed to prevent inadvertent contact (panel covers closed, no openings in conduit, etc.)?_____ Yes _____ N/A

Steam/Chemicals/Fluids/Air: 3.01,, Proper position of valves visually verified before chemicals added to system?_____ Yes _____ N/A

3.02,, Relief devices positioned so that the direction of discharge is not hazardous to personnel?_____ Yes _____ N/A

3.03,, Insulation reinstalled on surfaces that can reach a temperature of 135oF (57oC) or higher?_____ Yes _____ N/A

3.04,, Fixtures such as pipe hangers, valve handles and drain covers secured?_____ Yes _____ N/A

3.05,, Access openings in ventilation duct work closed?_____ Yes _____ N/A

3.06,, Drains for secondary containment structures closed to prevent release of materials to the environment?_____ Yes _____ N/A

3.07,, New or replacement pipes/tubing/hoses/valves rated for maximum operating pressure?_____ Yes _____ N/A

3.08,, Drain valves  such as condensate drains or bleed off mechanisms returned to designated position?_____ Yes _____ N/A

3.09,, Fluid conveyance paths visually verified to contain all required components?_____ Yes _____ N/A

3.10,, Tightness of fluid conveyance connections verified?_____ Yes _____ N/A

3.11,, Flexible hoses anchored to prevent whipping in case of hose or fitting failure?_____ Yes _____ N/A

3.12,, Drain plugs and fill caps replaced?_____ Yes _____ N/A

3.13,, Radiator-style or worm gear hose clamps not used to attach fittings to hoses?_____ Yes _____ N/A

3.14,, Replacement fluids match specification of replaced fluids unless approved through management of change process?_____ Yes _____ N/A

Mechanical:

4.01,, Components such as pumps, motors, cylinders, etc. installed insecure manner and tightness of fasteners verified?_____ Yes _____ N/A

4.02,, Correct machine rotation verified?_____ Yes _____ N/A

4.03,, Newly installed parts match specification of replaced parts unless approved through management of change process?_____ Yes _____ N/A

Abrasive Wheel Machinery:

5.01,, Spindle speed measured to verify that abrasive wheel rating greater than measured spindle speed?_____ Yes _____ N/A

5.02,, Fasteners on abrasive wheel guards checked for tightness?_____ Yes _____ N/A

Safety:

6.01,, Tools and materials used during maintenance activities removed from machine?_____ Yes _____ N/A

6.02,, Blocking devices used during maintenance activities to prevent machine movement or material flow removed?_____ Yes _____ N/A

6.03,, Fixed or adjustable guards reinstalled such that persons cannot reach moving parts or point of operation?_____ Yes _____ N/A

6.04,, Electronic safety devices such as light curtains and scanners placed in ‘active’ mode?_____ Yes _____ N/A

6.05,, Safety locks used for lockout removed from energy isolation devices?_____ Yes _____ N/A

6.06,, Fire protection systems restored to service?_____ Yes _____ N/A

Post Startup:

7.01,, Correct operation of emergency stops verified?_____ Yes _____ N/A

7.02,, Correct operation of light curtains/area scanners/pressure sensitive mats/safety interlocks verified?_____ Yes _____ N/A

7.03,, Correct operation of two-hand controls verified?_____ Yes _____ N/A

Authorization

The undersigned have reviewed the maintenance activity and have verified that ALL applicable items on the startup checklist have been completed. The equipment or process may NOT be released for production operations until approval is received from the functions listed below.________________________________________________________________Description of Maintenance Activity____________________________Machine Number_____________________________Work Order Number___________________

Persons Performing Maintenance Activity:

Name:_____________________________Signature:________________________Date:_____/_____/Name:_______________________Signature:__________________Date:_____/_____/Name:_______________________Signature:__________________Date:_____/_____/_____

Maintenance / Production Supervisor Authorizing Startup:

Name:_______________________Signature:__________________Date:_____/_____/_____

Remove all tools and debris from any maintenance activity once it has been completed. Inform the area supervisor or maintenance supervisor so appropriate hygiene and sanitation can be completed prior to the commencement of facility operations.

Initial completed items, include notes/data regarding PM instructions, sign and date when PM is complete. Report any work performed outside of pm scope. Any immediate repairs that will require more than 30 minutes, notify maintenance planner or maintenance team leader. Report any repairs that should be planned and scheduled to the maintenance planner. If equipment is not available for pm due to production, have line supervisor initial _______

____1. Contact the lead for the machine/area in order for them to sign-off on the time needed to perform the PM.

____2. Lead Printed Name:____________________________________________________________________________

____3. Lead Signed Name:____________________________________________________________________________

____4. Date:___________/____________/_________________

_____1. Verify that machine specific Lockout/Tagout procedures are posted in clear sight for this equipment.

_____2. Review LOTO procedures for accuracy to include any modifications that may have been made to this equipment.

_____3. If any changes are needed, indicate below and return to the maintenance planner/scheduler.

Perform pre-task analysis before beginning work.

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.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Part #, Description, and Quantity: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Tools required: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Resulting Preventive/Corrective work order number and description created because of this task: Work Order Number________________________________________________________________________Description________________________________________________________________________Work Order Number________________________________________________________________________Description________________________________________________________________________Are we doing this PM too often?________________________________________________________________________If yes, please explain________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Is the equipment number visible and in good condition?________________________________________________________________________Sign________________________________________________________________________Date________________________________________________________________________When complete, sign and date the Work Order in the appropriate area.

TURN IN COMPLETED PM SHEET AND REPORT ANY DISCREPANCIES TO YOUR IMMEDIATE SUPERVISOR. NOTES:______________________________________________________

_____1. Check for others. When the assigned repair or servicing task is completed and the machine is ready for testing or return to service, check the area surrounding the shut off unit to assure that no one will be exposed to danger when that machine is started up. Replace all guards and reactivate all interlocks.

_____2. Notify all affected employees that locks/tags are going to be removed and the machine is ready for operation.

_____3. Remove LOTO equipment. When the area is clear, remove all locks and de-activate all the energy isolating devices to restore energy and material to the machine. The same worker who installed the energy isolating devices and installed the locks must de-activate and remove them.

_____4. Test the machine. Perform any necessary testing of the restored machine to ensure it is in operable condition.

_____5. Notify the management that work is completed and the area has been returned to operational condition.

Return machine to service condition: Ensure all machine guards are in place and in good condition. Ensure all energy sources are activated. Communicate to the machine operator and or production supervisor of any changes or settings made during the inspection and the equipment is ready to return to production.

Establish 'Zero Energy State' before starting PM Task. '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. Please refer to MSDS for proper PPE on chemical being used in or around the equipment. Ensure all machine guards are in place and in good condition. Provide feedback of any items that have changed.

Check that machine safe guarding is functional. Verify functional operation (where applicable) of: light curtains, interlocks, two-hand controls, E-stops, and pull cords.

YOU MUST ADVISE THE MACHINE OPERATOR RESPONSIBLE FOR THIS PIECE OF EQUIPMENT, BEFORE BEGINNING WORK ON THIS EQUIPMENT. ISOLATE THE MACHINE SO THAT IT IS SAFE FROM ANY INTERRUPTION OR OTHER OPERATING EQUIPMENT. LOCK OUT THE POWER DISCONNECT SWITCH. ESTABLISH 'ZERO ENERGY STATE' BEFORE STARTING THIS PREVENTIVE MAINTENANCE TASK! 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! APPLY APPROPRIATE WARNING SIGNS AND PROVIDE DESCRIPTION AND LOCATION OF THOSE ENERGY SOURCES YOU SECURED BEFORE BEGINNING WORK. EXAMPLE: AT THE LOAD BLOCK AND AT PUSH BUTTON STATION. ALSO WHEN WORKING ON ANY JOB THAT REQUIRES YOU TO BE MORE THAT 6 FEET OFF OF THE FLOOR, YOU MUST WEAR A FULL BODY HARNESS. BEFORE RETURNING THE MACHINE TO SERVICE:

1.___ VERIFY ALL MACHINE GUARDS ARE IN PLACE AND ARE IN PROPER WORKING CONDITION

2.___ VERIFY ALL ELECTRICAL PANELS, CONTROLS AND JUNCTION BOXES ARE CLOSED AND SECURED 3.___ VERIFY E-STOPS ARE LOCKING TYPE AND FUNCTIONS CORRECTLY