Weekly Die PM - 4-Out

1a. Overall Die Condition

• Good

• Fair

• Poor

1b. Visible Die Damage Present

• Yes

• No

1d. Safety Concerns Identified

• Yes

• No

2a. Current Stroke Count

Meter name

2b. Estimated Strokes Since Last PM

2c. Abnormal Die Usage Observed

• Yes

• No

3a. Water Leaks Present at Die

• Yes
• No
• N / A

3d. Leak Fully Resolved

• Yes

• No

4a. Die Lubrication Operating Normally

• Yes
• No
• N / A

4b. Lube Lines / Ports Clear

• Yes

• No

5a. Loose or Missing Fasteners

• Yes

• No

5c. Mechanical Issues Requiring Follow-Up

• Yes

• No

6a. Die Sensors Secure and Aligned

• Yes
• No
• N / A

6b. Sensor Cables / Connections Intact

• Yes
• No
• N / A

6c. Sensor or Control Issues Identified

• Yes
• No
• N / A

7a. Die Safety Blocks / Stops in Place

• Yes
• No
• N / A

7b. Guards / Shields Secure

• Yes
• No
• N / A

7c. Safety Issues Identified

• Yes

• No

8a. Die Clean and Free of Debris

• Yes

• No

8b. Excess Oil / Water Accumulation

• Yes

• No

8c. Housekeeping Corrected During PM

• Yes

• No

9a. Corrective Actions Performed During PM

• Yes

• No

9c. Parts Replaced or Adjusted

10a. Additional Work Required

• Yes

• No

11a. Photos Uploaded

11b. Additional Notes

12a. Technician Name

12b. Date Completed

12c. Comments