Robot Equipment Safety Inspection Form
Please complete the safety inspection for the robot equipment below.
Inspector Full Name
First Name
Last Name
Date of Inspection
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Robot Equipment ID or Name
Is the equipment clean and free from debris?
Yes
No
Needs Maintenance
Are all safety guards in place and functional?
Yes
No
Needs Maintenance
Are emergency stop buttons operational?
Yes
No
Needs Maintenance
Is the equipment properly grounded?
Yes
No
Needs Maintenance
Are there any visible damages or wear?
Yes
No
If yes, please describe the damages or wear.
Additional comments or concerns
Inspector Signature
Submit
Should be Empty: