Angle Grinder Safety Form
Use this form to inspect the grinder, confirm required PPE and safe work conditions, and document any hazards, defects, or follow-up actions before use.
Operator and Job Information
Operator's Full Name
*
First Name
Middle Name
Last Name
Department / Team
*
Please Select
Operations
Maintenance
Production
Construction
Facilities
Other
Supervisor Name
*
Date of Inspection / Use
*
 -
Month
 -
Day
Year
Date
Job / Task Location
*
Task or Work Order Description
*
New Task or Routine Task
*
New Task
Routine Task
Angle Grinder and Accessory Details
Grinder Make/Model
*
Asset or Tool ID
*
Power Source Type
*
Corded Electric
Battery Powered
Pneumatic
Other
Disc/Wheel Type
*
Please Select
Cut-Off Wheel
Grinding Wheel
Flap Disc
Wire Brush
Other
Disc/Wheel Diameter or Size
*
Accessory Compatibility Confirmation
*
Compatible
Not Compatible
Unsure
Pre-Use Safety Inspection
Power cord / battery / air hose condition satisfactory
*
Yes
No
Switch functions properly
*
Yes
No
Guard installed and secure
*
Yes
No
Side handle installed and secure
*
Yes
No
Disc / wheel free of cracks, chips, or damage
*
Yes
No
Disc / wheel speed rating appropriate for grinder
*
Yes
No
Flanges and mounting hardware in good condition
*
Yes
No
No abnormal vibration or noise during test run
*
Yes
No
Comments / defects found
Tool removed from service if a critical defect is identified
*
Yes
No
Not applicable
PPE and Work Area Conditions
Required PPE Confirmed
*
Safety glasses
Face shield
Hearing protection
Task-appropriate gloves
Long sleeves / protective clothing
Safety footwear
Safety Glasses or Face Shield Worn
*
Yes
No
Hearing Protection Worn
*
Yes
No
Task-Appropriate Gloves Worn
*
Yes
No
Long Sleeves or Protective Clothing Worn
*
Yes
No
Safety Footwear Worn
*
Yes
No
Work Area Conditions Verified
*
Workpiece securely clamped
Adequate lighting
Clear floor and footing
Sparks/debris directed safely
Flammables removed or protected
Bystanders excluded
Ventilation/dust control adequate
Hot Work or Spark Control Measures Needed
*
Yes
No
Hazards Identified
Additional PPE or Work Area Notes
Operational Authorization and Acknowledgment
Operational authorization
*
Safe to proceed
Do not proceed
Needs supervisor review
Additional comments or restrictions
Incident, Near-Miss, and Follow-Up
Did an incident, near-miss, or injury occur?
*
No
Near-miss
Yes, injury
Yes, property damage
Other
Describe the incident or near-miss details
Corrective actions taken or required
Follow-up owner or maintenance contact
Follow-up completed or scheduled on
 -
Month
 -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: