Safety device selection form

Logo of the project TeSaMa	Form symbol XXX		Machine ID XXX-XXX			Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location		Mechanical injury hazard zone in the machine			Hazardous situation occurring due to access to the hazard zone
Selection of a safety device for the safety function (IEC 62046)
1. (Start) Safety function – description (go to 2) ……………………………………………………………				Notes:
2. (from 1) Design inputs – based on the risk assessment or in accordance with the requirement of a type C standard (go to 3) PL=….., (category = ……, DC = …….., MTTF = …….., architecture = …………) or SIL = …..				Notes:

3. (from 2) Requirement based on a type C standard active optoelectronic safety device – AOPD – light curtain or beam (go to 4) active optoelectronic safety devices – AOPDDR – laser scanner (go to 4) pressure-sensitive safety device (go to 7) interlocking guard without a locking device (go to 9) interlocking guard with a locking device (go to 10) two-handed control device (go to 11) one-handed hold-to-run device (go to 12) no requirement under type C standard (go to 13)				Notes:
4. (from 3, 16) Determination of the AOPD detection place (go to 5) vertical detection plane horizontal detection plane detection plane located at an angle				Notes:
5. (from 4) Determination of additional safety measures to prevent bypassing (go to 6) additional safety measures required to prevent bypassing (e.g. fixed guards) – please specify: ……………………………………………………………………………………………….. no additional safety measures required to prevent bypassing				Notes:
6. (from 5) Determination of requirements for the location of electro-sensitive safety equipment (go to 19) Location: ………………., height above floor = …………, safety distance from a danger zone = ………..., spacing of light curtain components = ……., other: …………..				Notes:

7. (from 3) Selection of the type of pressure-sensitive safety device (go to 8) pressure-sensitive mat pressure-sensitive floor pressure-sensitive strip pressure-sensitive edge pressure-sensitive end stop pressure-sensitive plate pressure-sensitive cord other pressure-sensitive devices				Notes:
8. (from 3) Determination of requirements for the location of a pressure-sensitive safety device (go to 19) Location: ………………., height above floor = …………, safety distance from a danger zone = ………..., other: …………..				Notes:

9. (from 3) Determination of requirements for the location of an interlocking guard without an locking device (go to 19) Location: ………………., safety distance from a danger zone =………..., other: …………..				Notes:

10. (from 3) Determination of requirements for the location of an interlocking guard with an locking device (go to 19) Location: ………………., other: …………..				Notes:

11. (from 3) Determination of requirements for the location of a two-handed control device (go to 19) Location: ………………., safety distance from a danger zone =………..., other: …………..				Notes:

12. (from 3) Determination of requirements for the location of a one-handed hold-to-run device (go to 19) Location: ………………., safety distance from a danger zone =………..., other: …………..				Notes:

13. (from 3) Risk level analysis risk level PL = a or SIL 1 at Se=1 – a possibility for using a one-handed hold-to-run device (go to 12) risk level PL = a or SIL 1 at Se=2 – a possibility for using a two-handed control device (go to 11) use of other safety devices (go to 14)
14. (from 13) Determination of requirements for the access frequency to the danger zone high access frequency (not less than once an hour) (go to 15) low access frequency (between once a year and once an hour) (go to 17) infrequent access required (not more than once a year) (go to 18)				Notes:
15. (from 14) Determination of environmental operating conditions for safety equipment environmental conditions for safety devices do not cause operating interferences and the devices can be installed (go to 16) environmental conditions for safety devices cause operating interferences or the devices cannot be installed (go to 7)				Notes:
16. (from 15) Selection of the type of electro-sensitive safety device (go to 4) active optoelectronic safety device – AOPD – light curtain or beam active optoelectronic safety device is – AOPDDR – laser scanner				Notes:

17. (from 14) Selection of the type of interlocking guard interlocking guard without an locking device – when safety distance requirements cannot be met (go to 19) interlocking guard with an locking device – when safety distance requirements can be met (go to 10)				Notes:

18. (from 14) Use of a fixed guard or enclosure – abandoned use of a safety measure involving control and the related safety function implementation (End)				Notes:

19. (from 6, 8, 9, 10, 11, 12) Use of combined safety measures – identification of another safety device (go to 20) active optoelectronic safety device – AOPD – light curtain or beam active optoelectronic safety device is – AOPDDR – laser scanner pressure-sensitive mat pressure-sensitive floor pressure-sensitive strip pressure-sensitive edge pressure-sensitive end stop pressure-sensitive plate pressure-sensitive cord other pressure-sensitive devices interlocking guard without an locking device interlocking guard with an locking device two-handed control device one-handed hold-to-run devices no combination of safety measures was applied (go to 21)				Notes:
20. (from 19) Determination of requirements for the location of another safety device (go to 21) Location: ………………., height above floor = …………, safety distance from a danger zone = ………..., other: …………..				Notes:

21. (from 19, 20) Verification of a meeting of safety distance requirements the minimum safety distance can be observed and a safety device can be properly installed on the machine (go to 22) the minimum safety distance cannot be observed or a safety device cannot be properly installed on the machine (go to 27)				Notes:
22. (from 21) Verification of a possibility for bypassing a safety device the danger zone cannot be accessed without activating a safety device (go to 24) the danger zone can be accessed without activating a safety device (go to 23)
23. (from 22) Use of additional fixed guards limiting a possibility of bypassing a safety device without its activation is required (go to 24) Dimensions and locations of additional fixed guards: ……………………………………………………………..
24. (from 22, 23) Verification of a possibility for people’s presence outside the safety device detection zone and simultaneously inside the danger zone (from 22, 23) there is no possibility for people to stay outside the safety device detection zone (go to 26) (from 22, 23) there is a possibility for people to stay outside the safety device detection zone, but damage can be avoided (go to 26) (from 22, 23) there is a possibility for people to stay outside the safety device detection zone and damage cannot be avoided (go to 26)
25. (from 24) Emergency stop device system should be provided inside the danger zone (go to 26) Emergency stop device type: …………………………………………..

26. (from 24, 25) Successful selection of a safety device. The safety function implementing with the involvement of a safety device can reduce the risk to the required level (End)

27. (from 21, 24) Failed selection of a safety device. The safety function will not reduce the risk to the required level. Determine new machine limitations and repeat the safety measure selection process based on control and related safety devices (End)

Persons selecting a safety device for the safety function					Date
Selection process summary

Assessment form of safety measures addressing mechanical hazards

Project logo TeSaMa	Form symbol XXX		Machine ID XXX-XXX			Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location		Mechanical injury hazard zone in the machine			Hazardous situation occurring due to access to the hazard zone
Assessment of safety measures applied to prevent mechanical hazards (minimum requirements)
1. (Start) Safety measures used safety measures not used (go to KN) a safety measure used (go to 2)				Notes:
2. (from 1) Is access to hazard zone required during normal production operation of the machine? access is not required (go to 3) access is required (go to 22)				Notes:
3. (from 2) Type of a safety measure used only fixed guard is used (go to 4) only safe start measures are used (go to 7) only secondary safety measures are used (go to 17) other safety measures are used (go to 22)				Notes:

4. (from 3) Does the fixed guard ensure complete restriction of access to the hazard zone from all directions (full guard or cover) guard ensures complete restriction of access (go to 5) guard does not ensure complete restriction of access (go to KN)				Notes:
5. (from 4, 6) Does the fixed guard meet the requirements of PN-EN 953+A1:2009 (checklist)? the guard meets the requirements (go to KP) the guard does not meet the requirements (go to KN)				Notes:
6. (from 4) Do the size and positioning of fixed guards comply with the requirements of the Regulation on general OSH requirements or PN-EN 953+A1:2009? dimensions and positioning of the guard meet the requirements (go to 5) dimensions and positioning of the guard do not meet the requirements (go to KN)				Notes:
7. (from 3) Is the risk low (low severity of the potential damage and low start up frequency, and the damage can be prevented)? the risk is low (go to 8) the risk is not low (go to KN)				Notes:
8. (from 7) Does the location of a safe start control device prevent reaching the hazard zone and allow its good observation? requirement met (go to 9) requirement not met (go to KN)				Notes:
9. (from 8) Is there an emergency stop device complying with requirements of PN-EN ISO 13850:2012 (checklist) near the safe start device? requirement met (go to 10) requirement not met (go to KN)				Notes:
10. (from 9) Type of measure used for safe start one-handed hold-to-run device used (go to 11) two-handed control device used (go to 12)				Notes:
11. (from 10) Is a dangerous movement of the machine started after acting on a one-handed hold-to-run control device and immediately stopped after terminating the action? requirement met (go to 14) requirement not met (go to KN)				Notes:
12. (from 10) Is a dangerous movement of the machine started only after simultaneously acting on both control devices of the two-handed control device and immediately stopped after terminating the action on at least one device? requirement met (go to 13) requirement not met (go to KN)				Notes:
13. (from 13) Is it necessary to terminate acting on both control devices in order to restart a dangerous movement of the machine? requirement met (go to 14) requirement not met (go to KN)				Notes:
14. (from 11, 13) Is a warning device used? warning device used (go to 15) warning device no used (go to KP)				Notes:
15 (from 14) Is the warning device switched on sufficiently in advance before starting a dangerous movement of the machine and, depending on the situation, switched off after starting the movement or after it is completed? requirement met (go to 16) requirement not met (go to KN)				Notes:
16. (from 15) Is the visual, audible, visual and audible warning device well visible, audible, visible and audible directly near the hazard zone? requirement met (go to KP) requirement not met (go to KN)				Notes:

17. (from 3) Is the risk low (low severity of the potential damage and low frequency of starting up, and the damage can be prevented)? the risk is low (go to 18) the risk is not low (go to KN)				Notes:
18. (from 17) The type of secondary safety measure warning device and an emergency stop device (go to 19) only emergency stop devices (go to 21) only a warning device (go to KN)				Notes:
19 (from 18) Is the warning device switched on sufficiently in advance before starting a dangerous movement of the machine and, depending on the situation, switched off after starting the movement or after it is completed? requirement met (go to 20) requirement not met (go to KN)				Notes:
20. (from 19) Is the optical, acoustic, optical-acoustic warning device well visible, audible, visible and audible directly near the hazard zone? requirement met (go to 21) requirement not met (go to KN)				Notes:
21. (from 19, 20) Is an emergency stop device meeting the requirements of PN-EN ISO 13850:2012 (checklist) used? requirement met (go to KP) requirement not met (go to KN)				Notes:

22. (from 2, 3) Is (Are) protective device(s) used? a fixed guard is used in conjunction with (a) protective device(s) (go to 23) only (a) protective device(s) is (are) used (go to 24)				Notes:
23. (from 22) Does the fixed guard meet the requirements of PN-EN 953+A1:2009 (checklist)? the guard meets the requirements (go to 24) the guard does not meet the requirements (go to KN)				Notes:
				Notes:
24. (from 22, 23) Type of protective device used one movable interlocking guard (go to 25) one movable interlocking guard with a locking device (go to 29) one pressure-sensitive protective device (go to 32) one electro-sensitive protective device (go to 37) several interoperating protective devices (go to 42)				Notes:
25. (from 24) Does the movable guard participate in carrying out automatic stop safety function? the movable guard participates in carrying out automatic stop safety function (go to 26) the movable guard does not participate in carrying out automatic stop safety function (go to KN)				Notes:
26. (from 25) Are normally closed contacts used for the disconnecting the switching device of a movable guard when opening? normally closed contacts are used (go to 27) normally closed contacts are not used (go to KN)				Notes:
27. (from 26) Is an access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to 28) access is possible (go to KN)				Notes:
28. (from 27) Does a movable guard interlock the starting of the machine when open? the interlock is carried out (go to KP) the interlock is not carried out (go to KN)				Notes:

29. (from 24) Does the opening of an interlocking guard with a locking device prevent the starting of the dangerous movement of the machine? opening of the guard prevents the starting of the dangerous movement of the machine (go to 30) the movable guard does not participate in carrying out automatic stop safety function (go to KN)				Notes:
30. (from 29) Is the starting of the dangerous movement of the machine possible only after closing and locking the guard? machine movement is possible only after closing and locking the guard (go to 31) machine movement is possible before closing or locking the guard (go to KN)				Notes:
31. (from 30) Is unlocking the guard possible only after a complete stop of the dangerous movement of the machine? unlocking occurs only after a complete stop of the hazardous motion (go to KP) unlocking occurs before a complete stop of the hazardous motion (go to KN)				Notes:

32. (from 24) A pressure-sensitive protective device participates in carrying out the safety function of automatic stop (go to 33) locking the start (go to 35) automatic stop and locking the start (go to 36)				Notes:
33. (from 32) Does the activation of a pressure-sensitive protective device stop the dangerous movement of the machine? activation of a pressure-sensitive protective device stops the dangerous movement of the machine (go to 34) activation of a pressure-sensitive protective device does not stop the dangerous movement of the machine (go to KN)				Notes:
34. (from 33, 36) Is access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to KP) access is possible (go to KN)				Notes:
35. (from 32) Does the activation of a pressure-sensitive protective device interlock the possibility of starting the dangerous movement of the machine? activation of the pressure-sensitive protective device interlocks the possibility of starting of the dangerous movement of the machine (go to KP) activation of the pressure-sensitive protective device does not interlock the possibility of starting of the dangerous movement of the machine (go to KN)				Notes:
36. (from 32) Does the activation of a pressure-sensitive protective device stop the dangerous movement of the machine, interlocking at the same time the possibility of its starting? activation of a pressure-sensitive protective device stops the dangerous movement of the machine and at the same time interlocks the possibility of its starting (go to 34) activation of the pressure-sensitive protective device does not stop the dangerous movement of the machine or it does not interlock the possibility of its starting (go to KN)				Notes:

37. (from 24) An electro-sensitive protective device participates in carrying out the safety function of: automatic stop (go to 38) interlocking the start (go to 40) automatic stop and interlocking the start (go to 41)				Notes:
38. (from 37) Does the activation of an electro-sensitive protective device stop the dangerous movement of the machine? activation of an electro-sensitive protective device stops the dangerous movement of the machine (go to 39) activation of an electro-sensitive protective device does not stop the dangerous movement of the machine (go to KN)				Notes:
39. (from 37, 40) Is access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to KP) access is possible (go to KN)				Notes:
40. (from 37) Does the activation of an electro-sensitive protective device interlock the possibility of starting the dangerous movement of the machine? activation of an electro-sensitive protective device interlocks the possibility of starting the dangerous movement of the machine (go to KP) activation of the electro-sensitive protective device does not interlock the possibility of starting the dangerous movement of the machine (go to KN)				Notes:
41. (from 37) Does the activation of an electro-sensitive protective device stop the dangerous movement of the machine and, interlocking at the same time the possibility of its starting? activation of an electro-sensitive protective device stops the dangerous movement of the machine and at the same time interlocks the possibility of its starting (go to 39) activation of an electro-sensitive protective device does not stop the dangerous movement of the machine or does not interlock the possibility of its starting (go to KN)				Notes:

42. (from 24) Does the activation of the first protective device on the way to the hazard zone stop the dangerous movement of the machine (automatic stop safety function)? activation of the first protective device on the way to the hazard zone stops the dangerous movement of the machine (go to 43) activation of the first protective device on the way to the hazard zone does not stop the dangerous movement of the machine (go to KN)				Notes:
43. (from 42) Is access to hazardous moving parts of the machine possible before they stop due to the activation of the first protective device on the way to the hazard zone (the condition of the safe distance is met)? access is not possible (go to 44) access is possible (go to KN)				Notes:
44. (from 43) Does the activation of the second protective device on the way to the hazard zone stop the dangerous movement of the machine (automatic stop safety function)? activation of the first protective device on the way to the hazard zone stops the dangerous movement of the machine (go to KP) activation of the first protective device on the way to the hazard zone does not stop the dangerous movement of the machine (go to KN)				Notes:

KN. Negative result of the assessment of compliance with minimum requirements the assessment demonstrated compliance with minimum requirements				Required scope of adjustment to minimum requirements

KP. Positive result of the assessment of compliance with minimum requirements the assessment demonstrated compliance with minimum requirements

Person carrying out the inspection of safety measures related to mechanical hazards					Date of the inspection
Assessment findings

Fixed or movable guard assessment form

Logo of the project TeSaMa		Form symbol XXX		Machine ID XXX-XXX				Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location			Installed guards
Fixed or movable guard assessment (according to PN-EN 953+A1:2009)
Item	Requirement				Requirement fulfilment		Notes:
					Yes or Not applicable	No
1.	The guard does not have to be removed or opened to perform the actions with respect to set-up, lubrication or maintenance (where possible in practical applications)
2.	The guard is suitable for holding off the parts that may be thrown out of the machine
3.	The guard is suitable for holding off the emissions of substances from the machine
4.	The guard is suitable for reducing the noise emissions from the machine
5.	The guard is suitable for reducing the radiation emissions from the machine
6.	The guard is suitable for reducing the effects of explosions of the materials that are found in the machine
7.	The design, construction and location of the guard prevent the access to the hazard zone and ensure appropriate safety distance from this zone
8.	Movable guard, if possible, is designed and located in a manner preventing the possibility of leaving a human locked in the hazard zone
9.	The guard is designed and made in a manner enabling the correct observation of the machine process
10.	The guard is designed taking into account the principles of ergonomics
11.	Removable parts of the guard have the dimensions and weight enabling their easy handling
12.	Parts of the guard that may be moved or transported manually are equipped or may be equipped with appropriate lifting measures
13.	Movable guards or removable parts of the guards are easy to use and do not require excessive effort
14.	Electrically driven movable guard does not present risk of injury as a result of pressure, force, speed, sharp edges
15.	The guard is designed, as far as possible, taking into consideration the expected correct manner of use and rationally predictable incorrect manner of use
16.	The guard itself does not produce hazards
17.	The guard is designed in a manner not causing the emergence of crushing or gripping places
18.	The guard is designed and made in a manner ensuring its durability throughout the life cycle
19.	The guard is designed in a manner ensuring the appropriate hygiene level
20.	The guard is designed in a manner ensuring its easy cleaning
21.	The guard is designed in a manner eliminating the process pollution
22.	The guard has no sharp edges or corners
23.	Welded, bent or mechanically performed joints of the guard have appropriate resistance to rational loads. The fasteners are used in appropriate bonding process and are made of proper materials. Mechanical connections have appropriate capacity, and the number and spacing of the connection points ensuring stability and inflexibility of the guard.
24.	Detachable parts of the guard may be removed only with the use of a tool
25.	If possible, removable guard does not remain in its place upon the removal of mounting elements
26.	Closed position (not causing the stop) of the movable guard is forced by gravitation, spring, hook, locking device or in another manner.
27.	Self-closing guards open not wider than it is required for the movement of detail. They are not locked in the open position
28.	Adjustable guards should be located in a place ensuring the minimum for the movement of detail
29.	Manually adjusted guards ensure the fixed location while performing the technological operation and are adjustable easily without the use of tools,
30.	Automatically adjusted guards are designed and made in such a manner that there is a minimum distance between the material and the guard
31.	Movable guards require positive action for their opening, are mounted to the machine or another fixed element by means of hinges or guide bars, which may not be removed without using a tool
32.	Control guards are used only when there is no possibility for the operator or part of his body remained in the hazard zone after closing the guard, the dimensions and shape of the machine ensure the operator or other person a full view of the machine/process, opening of the control guard or locked one is the only method of access to the hazard zone, locking device associated with the control guard has the highest possible reliability.
33.	The guard was designed to withstand rationally predictable impacts from the parts of the machine, details, broken tools, thrown out solid or liquid materials and impacts from the operator
34.	Supporting elements of the guards, guards frames and filling materials ensure a rigid and stable structure, and are resistant to deformation
35.	Guards and their parts are well fixed at anchoring points with appropriate durability, spacing and number, adequately to the expected load
36.	Movable parts of the guards, such as hinges, guide bars, handles, hooks are selected in a manner ensuring its reliable performance
37.	The guard holds noxious substances off by using impermeable material
38.	Guard material is resistant to predictable corrosive or oxidising agents from the product, process or environment
39.	Guard material counteracts the development of bacteria and may be easily cleaned or disinfected
40.	Guard material is not toxic in predictable conditions of use and is compatible with the process with which it is used
41.	Guard material has adequate properties ensuring the possibility to observe the process (perforation, mesh, colour), when required
42.	Guard material is appropriately transparent, when required, and may be replaced if needed
43.	Guard material mitigates stroboscopic effects, when required
44.	Guard material ensures electrostatic properties, when required
45.	Guard material in the conditions of defined temperature range or sudden changes of temperature does not degrade and does not emit toxic or flammable substances
46.	Guard material in the conditions of fire risk is resistant to ignition and ensures inflammation delay and does not absorb or emit flammable liquids or smokes, etc.
47.	When necessary, guard material ensures reduction of noise and vibrations
48.	In welding or laser radiation conditions guard material protects against harmful radiation, but ensures the possibility of process observation, when necessary
49.	The guard was designed in a manner preventing climbing onto it
50.	If the removal of the guard is expected, its fixing elements remain adjoined to the guard or machine
51.	In conditions of vibrations the guard is mounted with the use of secured nuts, spring washers, etc.
52.	If the access to the zone limited by a guard is associated with hazard exposure, warning signs have been placed at the access points
53.	The guard limiting the access to the hazard zone is painted in bright, contrasting colour
54.	The guard is designed in a manner minimising adverse psychological effects

Persons performing the assessment of the guards							Date of the assessment
Post-assessment conclusions

Emergency stop device assessment form

Logo of the project TeSaMa		Form symbol XXX		Machine ID XXX-XXX				Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location			Installed emergency stop devices
Emergency stop device assessment (according to PN-EN ISO 13850:2012)
Item	Requirement				Requirement fulfilment		Notes:
					Yes or Not applicable	No
1.	Emergency stop function is always available
2.	Emergency stop function is always effective
3.	Emergency stop function always overrides other functions in all work modes of the machine
4.	No start signal is effective with respect to actions stopped by the initiation of performance of emergency stop function, unless it is reset
5.	Emergency stop function is not used as a measure substituting safety functions performed by technical protective measures
6.	Emergency stop function does not impair the effectiveness of protective devices and other devices performing safety functions
7.	Emergency stop function upon activation of the control element properly causes the stop of movements and actions of the machine presenting hazard (by means of selection of an optimal delay value, function category, adequate stop sequence)
8.	Emergency stop function does not require the operator to take into consideration the effects of such stop
9.	Emergency stop runs according to 0 or 1 category
10.	Sending the emergency stop signal is sustained until it is reset manually
11.	Resetting the emergency stop function is possible only in the place of its initiation
12.	Resetting the emergency stop function does not start up the machine
13.	Restarting the machine is possible only upon resetting the emergency stop function in any place that it was initiated
14.	Parts, devices and elements used to perform the emergency stop functions are well-suited, mounted, connected with each other and secured ensuring the correct operation in expected conditions of use and with expected environmental impact
15.	The control elements in the emergency stop device are: mushroom buttons, wires, cables, bars, handles and in special applications – pedals without guards
16.	Emergency stop device has been placed at each control station, unless the risk assessment indicates that it is not necessary
17.	Emergency stop devices are easily accessible
18.	Emergency stop devices can be activated by the operator or other persons
19.	The measures preventing accidental start-up of the emergency stop device do not impair its availability
20.	Emergency stop devices comply with the rule of effective opening with mechanical locking
21.	Emergency stop control element is red and, if possible, the background behind the control element is yellow
22.	In case of use of the wires or cables requiring the improvement of visibility, the flags or other solutions were applied
23.	In case of use of labels, an appropriate IEC symbol was used
24.	In case of using cables or wires as emergency stop control elements the following were taken into consideration: deflections necessary to initiate emergency stop, maximum deflections, minimum distances from the next object in its surroundings, ensuring appropriate visibility for the operator, necessary force and its direction required for activation
25.	The solutions preventing the hazards caused by a break or disconnection of cable or wire were applied
26.	The measures for resetting the emergency stop devices based on cables or wires are located in places, from which their entire length is visible
27.	Operating instruction for resetting of cabled or wired emergency stop devices includes the requirements for checking the machine along the entire length of the cable or wire

Persons performing the assessment of the emergency stop device							Date of the assessment
Conclusions from the assessment

Assessment form for safety-related control systems

Logo of the project TeSaMa		Form symbol XXX		Machine ID XXX-XXX				Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location			Main elements of the safety-related machine control system
Assessment of the safety-related machine control system
Item	Requirement				Fulfilment of the requirement		Notes:
					Yes or Not applicable	No
1.	Safety-related machine control devices are visible.
2.	Safety-related machine control devices are identifiable without the need to mark them or are marked with comprehensible symbol or text in Polish.
3.	Safety-related machine control devices are located outside danger areas in such a way that their use does not pose any additional hazards.
4.	Safety-related machine control devices used to stop it are only red or black and there are not any other red or black control devices.
5.	Safety-related machine control devices do not pose hazards related to their accidental tripping.
6.	Safety-related machine control devices are buttons for starting the operation, do not protrude above the cover or are covered (unintentional start of the machine is prevented).
7.	Safety-related machine control devices differ from other buttons and starting elements (levers, handwheels, pedals), have resistance preventing their self-actuation (actuating force > 5N, e.g. under the influence of vibrations or accidental contact) and are prevented from accidental actuation (e.g. press pedal cover).
8.	The machine operator can check from the location of control devices used for starting if there is anyone in the danger area or, if this is not possible, an acoustic or visual warning signal is given before starting.
9.	An exposed employee has the time or means to avoid the hazard caused by starting or stopping the machine.
10.	The control system of the machine is selected taking into consideration the expected scope of risk reduction, the effect of the environmental factors and expected operating conditions of the machine.
11.	The machine can only be started by a deliberate operation of the control designed for this purpose which appropriately activates the control system.
12.	The machine is equipped with a control system designed to stop it completely and safely.
13.	The control function designed to stop the machine has priority over the control function designed to start it.
14.	Restarting the machine after a stoppage due to a process situation (deliberate action by the operator, stopping automatically at the end of the process cycle) and safety-related stoppage (emergency stop, tripped protective device, failure, failure of the power supply) is possible only through a deliberate action on a control device designed for this purpose.
15.	The control system ensures that no significant changes in the parameters of the machine, in particular speed and pressure, must occur accidentally (they require a deliberate response to the respective control device or are carried out in automatic mode).
16.	Each workstation is fitted with a control device to stop the entire machine or its part, normally or in an emergency, depending on the existing hazards, so that the machinery is rendered safe.
17.	The control system ensures disconnecting the machine drives from energy in the case of its stoppage.
18.	Safety function(s) of normal start is carried out as intended (confirmation by operation tests)
19.	Safety function(s) of normal stop is carried out as intended (confirmation by operation tests)
20.	Safety function(s) of emergency stop is carried out as intended (confirmation by operation tests)
21.	Safety function(s) of preventing unexpected start is carried out as intended (confirmation by operation tests)
22.	Safety function(s) of preventing start after power supply failure and reestablishment or following its fluctuation is carried out as intended (confirmation by operation tests)
23.	Safety function(s) of energy disconnection and dissipation of energy (e.g. braking, pressure discharge) is carried out as intended (confirmation by operation tests and measurements, as necessary)
24.	Safety function(s) related to the adjustment of operating modes and/or operating parameters is carried out as intended (confirmation by operation tests)
25.	Safety function(s) of the release of stored energy after stoppage is carried out as intended (confirmation by operation tests and, if required, measurements of energy release time).
26.	Safety function(s) of automatic stoppage due to activation (tripping) of detecting protective devices is carried out as intended (confirmation by operation tests and verifying the parameters of protection devices).
27.	Safety function(s) of automatic stoppage due to opening of an interlocking guard is carried out as intended (confirmation by operation tests).
28.	Safety function(s) of automatic stoppage due to the activation of the sensor of a machine parameter limit value is carried out as intended (confirmation operation tests and verification of thresholds values).
29.	Safety function(s) of automatic stoppage due to machine failure is carried out as intended (confirmation by tests using failure simulation techniques).
30.	Safety function(s) of start interlocking in the activated state of detecting protective devices is carried out as intended (confirmation by operation tests and verifying the parameters of protective devices).
31.	Safety function(s) of start interlocking in the condition of opening the interlocking guard is carried out as intended (confirmation by operation tests).
32.	Safety function(s) of start interlocking in the condition of the activation of the sensor of a machine parameter limit value is carried out as intended (confirmation by operation tests and verification of threshold values).
33.	Safety function(s) of start interlocking in the machine failure condition is carried out as intended (confirmation by tests using failure simulation techniques).
34.	Safety function(s) of preventing one-handed start by using a two-hand control device is carried out as intended (confirmation by operation tests and, if required, measurements of energy release time).
35.	Safety function(s) of locking guard interlocking is carried out as intended (confirmation by operation tests).
36.	Safety function(s) of manual overriding (resetting) of the locking function is carried out as intended (confirmation by operation tests).
37.	Safety function(s) of automatic suspension of a safety functions (muting) is carried out as intended (confirmation by operation tests).
38.	Safety function(s) related to operating modes of the machine (set-up, release of trapped persons etc.) is carried out as intended (confirmation by operation tests).
39.	Adequate safety distance is ensured in the case of safety function(s) of tripping using detecting protective devices.
40.	All start and stop states of the machine are clearly and legibly represented by the state of the signalling elements.
41.	The protective devices used are properly fastened, their position is stable, it has not been changed and cannot be easily changed.
42.	Access to the hazard zone is only possible through the detection zone of detective protective devices or after opening the interlocking guard.
43.	Measures have been used to prevent circumvention of protective devices and disabling (deactivating) security functions.
44.	Protective devices used do not impede the operation of the machine, e.g. by impeding access to work areas or excessively limiting the field of vision.
45.	Violation of the detection zone AOPD or AOPDDR with an appropriate test probe activates the appropriate automatic stop functions or start locking function.
46.	Exerting adequate pressure with an appropriate test probe in the effective sensitivity area of the pressure-sensitive device activates the appropriate automatic stop functions or start locking function.
47.	Opening an interlocking guard activates the appropriate automatic stop functions or start locking function.
48.	Electrical circuits of safety-related parts of control systems are supplied from the power supply source ensuring sufficient galvanic isolation in relation to electrical power supply circuits of machine drives.
49.	One pole of each voltage source supplying the circuits of safety-related parts of control systems is effectively connected with the system of protective connections.
50.	Machine operating rules provide for the checking of the most important safety functions each time before starting work on the machine by the employee on the working day and recording the checking activities in the relevant register.
51.	Periodic maintenance and functional checks of devices which make up the safety-related parts of control systems are provided by qualified personnel; these activities are recorded in the relevant register.
52.	Acquisition and use of original spare parts or replacement parts authorized by the manufacturer is ensured for the repair of safety-related parts of control systems and any repair work is recorded in the relevant register.

Persons carrying out the assessment of the safety-related machine control system							Date of the assessment
Conclusions from the assessment

Assessment form of safety measures addressing mechanical hazards

Logo of the project TeSaMa	Form symbol XXX		Machine ID XXX-XXX			Form date (date when assessment of safety measures addressing mechanical hazards started) xxxx-xx-xx
Machine name, type and location		Mechanical injury hazard zone in the machine			Hazardous situation occurring due to access to the hazard zone
Assessment of used safety measures related to mechanical hazards (minimum requirements)
1. (Start) Safety measures used safety measures not used (go to KN) a safety measure used (go to 2)				Notes:
2. (from 1) Is access to hazard zone required during normal production operation of the machine? access is not required (go to 3) access is required (go to 22)				Notes:
3. (from 2) Type of safety measure used only fixed guard is used (go to 4) only safe start measures are used (go to 7) only secondary safety measures are used (go to 17) other safety measures are used (go to 22)				Notes:

4. (from 3) Does the fixed guard ensure complete restriction of access to the hazard zone from all directions (full guard or cover) guard ensures complete restriction of access (go to 5) guard does not ensure complete restriction of access (go to KN)				Notes:
5. (from 4, 6) Does the fixed guard meet the requirements of PN-EN 953+A1:2009 (checklist)? the guard meets the requirements (go to KP) the guard does not meet the requirements (go to KN)				Notes:
6. (from 4) Does the size and positioning of fixed guards comply with the requirements of the Regulation on general OHS requirements or PN EN 953+A1:2009? dimensions and positioning of the guard meet the requirements (go to 5) dimensions and positioning of the guard do not meet the requirements (go to KN)				Notes:
7. (from 3) Is the risk low (low severity of the potential damage and low frequency of starting up, and the damage can be prevented)? the risk is low (go to 8) the risk is not low (go to KN)				Notes:
8. (from 7) Does the location of a safe start control device prevent reaching the danger zone and allow its good observation? requirement met (go to 9) requirement not met (go to KN)				Notes:
9. (from 8) Is there an emergency stop device complying with requirements of PN-EN ISO 13850:2012 (checklist) near the safe start device? requirement met (go to 10) requirement not met (go to KN)				Notes:
10. (from 9) Type of measure used for safe start one-handed hold-to-run device used (go to 11) two-handed control device used (go to 12)				Notes:
11. (from 10) Is a dangerous movement of the machine started after acting on a one-handed hold-to-run control device and immediately stopped after terminating the action? requirement met (go to 14) requirement not met (go to KN)				Notes:
12. (from 10) Is a dangerous movement of the machine started only after simultaneously acting on both control devices of the two-handed control device and immediately stopped after terminating the action on at least one device? requirement met (go to 13) requirement not met (go to KN)				Notes:
13. (from 13) Is it necessary to terminate acting on both control devices in order to restart a dangerous movement of the machine? requirement met (go to 14) requirement not met (go to KN)				Notes:
14. (from 11, 13) Is a warning device used? warning device used (go to 15) warning device not used (go to KP)				Notes:
15 (from 14) Is the warning device switched on sufficiently in advance before starting a dangerous movement of the machine and, depending on the situation, switched off after starting the movement or after it is completed? requirement met (go to 16) requirement not met (go to KN)				Notes:
16. (from 15) Is the optical, acoustic, optical-acoustic warning device well visible, audible, visible and audible directly near the danger zone? requirement met (go to KP) requirement not met (go to KN)				Notes:

17. (from 3) Is the risk low (low severity of the potential damage and low frequency of starting up, and the damage can be prevented)? the risk is low (go to 18) the risk is not low (go to KN)				Notes:
18. (from 17) The type of secondary safety measure warning device and an emergency stop device (go to 19) only emergency stop devices (go to 21) only a warning device (go to KN)				Notes:
19 (from 18) Is the warning device switched on sufficiently in advance before starting a dangerous movement of the machine and, depending on the situation, switched off after starting the movement or after it is completed? requirement met (go to 20) requirement not met (go to KN)				Notes:
20. (from 19) Is the optical, acoustic, optical-acoustic warning device well visible, audible, visible and audible directly near the danger zone? requirement met (go to 21) requirement not met (go to KN)				Notes:
21. (from 19, 20) Is an emergency stop device meeting the requirements of PN-EN ISO 13850:2012 (checklist) used? requirement met (go to KP) requirement not met (go to KN)				Notes:

22. (from 2, 3) Is (Are) protective device(s) used? a fixed guard is used in conjunction with (a) protective device(s) (go to 23) only (a) protective device(s) is (are) used (go to 24)				Notes:
23. (from 22) Does the fixed guard meet the requirements of PN-EN 953+A1:2009 (checklist)? the guard meets the requirements (go to 24) the guard does not meet the requirements (go to KN)				Notes:
				Notes:
24. (from 22, 23) Type of protective device used one movable interlocking guard (go to 25) one movable interlocking guard with a locking device (go to 29) one pressure-sensitive protective device (go to 32) one electro-sensitive protective device (go to 37) several interoperating protective devices (go to 42)				Notes:
25. (from 24) Does the movable guard participate in carrying out automatic stop safety function? the movable guard participates in carrying out automatic stop safety function (go to 26) the movable guard does not participate in carrying out automatic stop safety function (go to KN)				Notes:
26. (from 25) Are normally closed contacts used for the disconnecting the switching device of a movable guard when opening? normally closed contacts are used (go to 27) normally closed contacts are not used (go to KN)				Notes:
27. (from 26) Is access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to 28) access is possible (go to KN)				Notes:
28. (from 27) Does a movable guard interlock the starting of the machine when open? the interlock is carried out (go to KP) the interlock is not carried out (go to KN)				Notes:

29. (from 24) Does the opening of an interlocking guard with a locking device prevent the starting of the dangerous movement of the machine? opening the guard prevents the starting of the dangerous movement of the machine (go to 30) the movable guard does not participate in carrying out the automatic stop safety function (go to KN)				Notes:
30. (from 29) Is the starting of the dangerous movement of the machine possible only after closing and locking the guard? machine movement is possible only after closing and locking the guard (go to 31) machine movement is possible before closing or locking the guard (go to KN)				Notes:
31. (from 30) Is unlocking the guard possibly only after a complete stop of the dangerous movement of the machine? unlocking occurs only after a complete stop of the hazardous motion (go to KP) unlocking occurs before a complete stop of the hazardous motion (go to KN)				Notes:

32. (from 24) Does a pressure-sensitive protective device participate in carrying out the safety function? automatic stop (go to 33) locking the start (go to 35) automatic stop and locking the start (go to 36)				Notes:
33. (from 32) Does the activation of a pressure-sensitive protective device stop the dangerous movement of the machine? activation of a pressure-sensitive protective device stops the dangerous movement of the machine (go to 34) activation of a pressure-sensitive protective device does not stop the dangerous movement of the machine (go to KN)				Notes:
34. (from 33, 36) Is access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to KP) access is possible (go to KN)				Notes:
35. (from 32) Does the activation of a pressure-sensitive protective device interlock the possibility of starting the dangerous movement of the machine? activation of the pressure-sensitive protective device interlocks the possibility of starting the dangerous movement of the machine (go to KP) activation of the pressure-sensitive protective device does not interlock the possibility of starting the dangerous movement of the machine (go to KN)				Notes:
36. (from 32) Does the activation of a pressure-sensitive protective device stop the dangerous movement of the machine, interlocking at the same time the possibility of its starting? activation of a pressure-sensitive protective device stops the dangerous movement of the machine and at the same time interlocks the possibility of its starting (go to 34) activation of the pressure-sensitive protective device does not stop the dangerous movement of the machine or it does not interlock the possibility of its starting (go to KN)				Notes:

37. (from 24) Does an electro-sensitive protective device participate in carrying out the safety function? automatic stop (go to 38) locking the start (go to 40) automatic stop and locking the start (go to 41)				Notes:
38. (from 37) Does the activation of an electro-sensitive protective device stop the dangerous movement of the machine? activation of an electro-sensitive protective device stops the dangerous movement of the machine (go to 39) activation of an electro-sensitive protective device does not stop the dangerous movement of the machine (go to KN)				Notes:
39. (from 37, 40) Is access to hazardous moving parts of the machine possible before they stop (the condition of the safe distance is met)? access is not possible (go to KP) access is possible (go to KN)				Notes:
40. (from 37) Does the activation of an electro-sensitive protective device interlock the possibility of starting the dangerous movement of the machine? activation of an electro-sensitive protective device interlocks the possibility of starting the dangerous movement of the machine (go to KP) activation of the electro-sensitive protective device does not interlock the possibility of starting the dangerous movement of the machine (go to KN)				Notes:
41. (from 37) Does the activation of an electro-sensitive protective device stop the dangerous movement of the machine and, interlocking at the same time the possibility of its starting? activation of an electro-sensitive protective device stops the dangerous movement of the machine and at the same time interlocks the possibility of its starting (go to 39) activation of an electro-sensitive protective device does not stop the dangerous movement of the machine or does not interlock the possibility of its starting (go to KN)				Notes:

42. (from 24) Does the activation of the first protective device on the way to the danger zone stop the dangerous movement of the machine (automatic stop safety function)? activation of the first protective device on the way to the danger zone stops the dangerous movement of the machine (go to 43) activation of the first protective device on the way to the danger zone does not stop the dangerous movement of the machine (go to KN)				Notes:
43. (from 42) Is access to hazardous moving parts of the machine possible before they stop due to the activation of the first protective device on the way to the danger zone (the condition of the safe distance is met)? access is not possible (go to 44) access is possible (go to KN)				Notes:
44. (from 43) Does the activation of the second protective device on the way to the danger zone stop the dangerous movement of the machine (automatic stop safety function)? activation of the first protective device on the way to the danger zone stops the dangerous movement of the machine (go to KP) activation of the first protective device on the way to the danger zone does not stop the dangerous movement of the machine (go to KN)				Notes:

KN. Negative result of the assessment of compliance with minimum requirements the assessment demonstrated compliance with minimum requirements				Required scope of adjustment to minimum requirements

KP. Positive result of the assessment of compliance with minimum requirements the assessment demonstrated compliance with minimum requirements

Person carrying out the inspection of safety measures related to mechanical hazards					Date of the inspection
Assessment findings