Glass Crushing Safety Procedure Form
Complete this form to ensure all steps of the glass crushing safety procedure are followed and documented.
Full name of operator
*
First Name
Last Name
Date and time of procedure
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Have you inspected the glass crusher for any visible damage or defects before use?
*
Yes, no defects found
No, defects found (do not operate)
Is all required personal protective equipment (PPE) being worn?
*
Safety goggles
Cut-resistant gloves
Protective apron
Hearing protection
Has the work area been cleared of unnecessary materials and bystanders?
*
Yes, area is clear
No, area not clear (do not proceed)
Did you test the emergency stop function before operation?
*
Yes, emergency stop works
No, emergency stop not working (do not operate)
Were any incidents, near misses, or unsafe conditions observed during operation?
*
No incidents or unsafe conditions
Yes, incident or unsafe condition occurred (describe below)
If you answered yes above, please describe the incident or unsafe condition.
Has the area and equipment been cleaned and secured after use?
*
Yes, area and equipment are clean and secured
No, further cleaning or securing needed
I confirm that I have read and followed the Glass Crushing Safety Procedure and reported any issues as required.
*
I confirm
Submit
Should be Empty: