•/ #* FIELD SHEET FOR RISK ANALYSIS OF MACHINERY AND EQUIPMENT

•1 Megaforce
Collect the requested information in accordance with the requirements established by the official Mexican
standard NOM-004-STPS-1999, Protection systems and safety devices in machinery and equipment used in work centers.

Inspection date: Hour: Machine or equipment running: YES NO

General data
Tradename: Brand:

Internal Name: Model:

Frequency of use: Area:
Classificatio Energies used Present Physical Direct environmental aspects Use tools
n Equipme Electrical Risks Noise, lighting YES NO Which ones:
nt
Machine Mechanics Chemicals Chemical substances
Does it generate Pneumatics Biological Residuous generation
waste? RME
N/A Hydraulics Mechanical
— Emissions to the atmosphere Exposed body parts:
RSU PR Combustion Environment Use of water or impact on soil
al of the process (write down the tools, if any, to handle the machine or equipment)
Describe the use of the machine or equipment and stages

Security aspects
From the aspects mentioned below, collect photographic evidence that will be used in the electronic report.
Operating voltage Number of bimanual controls
Static electricity generation
Number of emergency stops Brake control
Particle projection
Number of moving parts Number of additional tools Indicator systems
Heat generation points Number of protectors on the machine/equipment Signaling
Number of cutting surfaces Number of limit switches

Safety sheets available

If there are any observations on the aspects evaluated or if you add any that are not mentioned, write them down in this section:

Risks associated with machinery or equipment

Physics Chemicals Ergonomic Mechanics Environment
noises Corrosive Forced postures Court Fire
Radiations Explosive Repetitive movements catch Spills
Vibrations Toxic Customized designs Manual Friction Emissions
Lightning Flammable handling of loads Difficulty in Impact Part. Suspended
± Temperature Reagent adaptation Visual, acoustic, and Projection Other
Humidity Fuel thermal comfort Burn :
Write down important aspects of the review (names of chemicals, physical points or risk tasks of the machine/equipment)

Additional
Personal protective equipment required by manufacturer:
Most common injuries during normal operation:
Training required to operate the machine/equipment:
Name of the person carrying out the evaluation Name of who verifies the information