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Sample form - Periodic Inspection Record for Partial Revolution Power Presses.

The purpose of this form is to provide compliance assistance information to interested parties required to comply with Subpart O, 1910.217(e) regulations for mechanical power presses. This non-mandatory format has been developed to list components of machines common to most power presses, although it is not an exhaustive listing. The employer is responsible for consulting the manufacturers recommendations on each power press in operation and fully complying with the letter and intent of 1910.217(e).

MACHINE NO.__________________________    DEPARTMENT____________________________
DATE________________

OK NOT OK PART INSPECTED IF NOT OK, CONDITION DATE OF CORRECTION
___ _____ Floor Condition, Clean _______________________________________ _______________
___ _____ Piping to Press (air, power) _______________________________________ _______________
___ _____ Lighting to Press _______________________________________ _______________
___ _____ Operator Properly Trained _______________________________________ _______________
___ _____ Bolster Plate Secure _______________________________________ _______________
___ _____ Inclining Screw, Ratchet, Screw Pin, Cotters for Screw Pin _______________________________________ _______________
___ _____ Tie Rods _______________________________________ _______________
___ _____ Leg Clamp & Pivot Bolt _______________________________________ _______________
___ _____ Brake-Collar _______________________________________ _______________
___ _____ Collar Key Strap, Fixed Half, Air Cylinder Operating, Hinged Half, Hinge Pin, Adjustment Spring, Band Nut Adjustment _______________________________________ _______________
___ _____ Fly Wheel End Collar Pin _______________________________________ _______________
___ _____ All Parts & Screws Secure _______________________________________ _______________
___ _____ Frame & Base for Cracks _______________________________________ _______________
___ _____ Bearing Clearances _______________________________________ _______________
___ _____ Slibe-Jib Clearances _______________________________________ _______________
___ _____ Main-Drive (belts, gears) _______________________________________ _______________
___ _____ Air Gauge (condition-accuracy) _______________________________________ _______________
___ _____ Push-Palm Buttons & Wiring _______________________________________ _______________
___ _____ Ground Fault Potential _______________________________________ _______________
___ _____ Rotary Limit Switch Secure & Cams, Relays Secure & Adjusted _______________________________________ _______________
___ _____ Operator's Station Secure _______________________________________ _______________
___ _____ Main Control Cabinet Secure & Closed After Inspection for Oil, Grease, etc., and Proper Functioning of All Components, Devices Contained Therein _______________________________________ _______________
___ _____ Main Motor Controls Operating _______________________________________ _______________
___ _____ Slide Adjust Motor Controls _______________________________________ _______________
___ _____ Designated Wiring Secure at Proper Terminal Points _______________________________________ _______________
___ _____ Foot Switch, Spring & Wiring _______________________________________ _______________
___ _____ Lubrication Operating at all Designated Points _______________________________________ _______________
___ _____ Main Clutch Valves Operating _______________________________________ _______________
___ _____ Brake Operating, Clean Adjusted _______________________________________ _______________
___ _____ Stopping Time at 90o in Milliseconds _______________________________________ _______________
___ _____ Safe Distance of Safeguard OK _______________________________________ _______________
___ _____ Anti-Repeat _______________________________________ _______________
___ _____ Barrier Guard Adjusted to Table 0-10 _______________________________________ _______________

COMMENTS:__________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

INSPECTED
BY:________________________________________________________________
                                                      (Name and Job Title)
Signature:____________________________________________________
                                                            (Name)
PRESS APPROVED FOR
OPERATION________________________________________________________
RED
TAGGED______________________________________________________________________