Open Issues & Safety Evaluation
Sender's E-Mail
Company
Customer Contact
Serial Number
Model Number
Contact Email
DEL Tech
Date
Detailed Description of Open Issues
Is all safety guarding in position? YesNo
Note: If a guard is not in position, please note the location of the missing guard in the field below:
Are all moving parts properly guarded and not accessible by hand? YesNo
Note: If a moving part is accessible by hand, please note the location of this potential hazard in the field below:
Are all safety interlocks operational? YesNo
Note: If a safety lock is NOT operational, please note the location of this potential hazard in the field below:
Are all electrical disconnects operating correctly? YesNo
Note: If an electrical disconnect is NOT operational, please note the location of this potential hazard in the field below:
Are all E-stops functioning properly? YesNo
Note: If an E-stop is NOT functioning properly, please note the location of this potential hazard in the field below:
Note: It is the customers responsibility to address all safety related issues noted, in a timely manner, unless otherwise stated in writing. A copy of this evaluation will be sent to the customer contact listed. In addition, a copy will be placed in the sales order folder by the Customer Service Manager along with a return receipt (e-mail).
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