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U.S. Department of Labor | |
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| Occupational Safety & Health Administration | ||||||
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| Machine Guarding eTool > Mechanical Power Presses > Appendix H | |
| Appendix H | |
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Sample Report - MECHANICAL POWER PRESSES Point of Operation Injury Report [1910.217(g)]
EMPLOYER Name________________________________________________________________________________ Address____________________________________________________________________Zip________ INJURED EMPLOYEE Name________________________________________________________________________________ Description of Injury____________________________________________________________________ _____________________________________________________________________________________ Date of Injury__________________________________________________________________________ Task Being Performed____________________________________________________________________ _____________________________________________________________________________________ (Operation, Set-Up, Maintenance or Others - Be Specific) PRESS DESCRIPTION Type of Press Clutch_____________________________________________________________________ (Full Revolution, Part Revolution or Direct Drive) Type of Safeguards Being Used_____________________________________________________________ _______________________________________________________________________________________ (2-Hand Control; 2-Hand Trip; Fixed Barrier Guard; Adjustable Barrier Guard; Type"A" Gate or Movable Barrier Guard; Type "B" Gate or Movable Barrier Guard; Presence Sensing Device; Pull Outs, Restraints, Hold Outs; etc.) ACCIDENT CAUSE Cause of Accident_______________________________________________________________________ ______________________________________________________________________________________ (Repeat of Press; Safeguard Failure; Removing Stock Part of Scrap; No Safeguard Provided; Safeguard Provided but not Being Used; Incorrect Control Mode Used or Other; Improper Usage of Adjustment; Be Specific) MACHINE LOADING Type of Feeding________________________________________________________________________ _____________________________________________________________________________________ (Manual with Hands in Die or with Hands Out of Dies; with Hand Tools; Semi-Automatic or Others; Be Specific) PRESS ACTUATION Means Used to Actuate Press Stroke________________________________________________________ ______________________________________________________________________________________ (Foot Trip; Foot Control; Hand Trip; Hand Control; Be Specific) OPERATORS Number of Personnel Required for Operation________________________________________________________________________ Number of Operators Provided with Controls and Safeguards_________________________________________________________ DATE OF REPORT______________________________________________________________________________ PREPARED BY___________________________________________________________________________________ OFFICIAL POSITION_____________________________________________________________________________ |
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