Upon Completion of a Machine Maintenance.

Return the system to normal operation.

• Yes
• No
• N / A

Verify motor rotation direction is correct.

• Yes
• No
• N / A

Verify lubrication and remove any excess oil or grease.

• Yes
• No
• N / A

Ensure all connections are closed and tight.

• Yes
• No
• N / A

Notify Production of completion.

• Yes
• No
• N / A

Person Notified

All tools are cleaned and sanitized, if applicable.

• Yes
• No
• N / A

Re-Install any guards removed and ensure safety devices are in place and operable.

• Yes
• No
• N / A

Time of Completion:

Work Completed on (Date):

Completed by:

Actual Time/Hours on Job:

Initial that all Parts/Tools are accounted for:

Name of Supervisor Notified that work is complete:

LOTO

• Yes
• No
• N / A

Confined Space Entry

• Yes
• No
• N / A

Hot Work Permit #

• Yes
• No
• N / A

Product or Ingredients removed

• Yes
• No
• N / A

Product or Ingredients put back

• Yes
• No
• N / A

Tools placed on a White Mat

• Yes
• No
• N / A

Tools Washed and Sanitized

• Yes
• No
• N / A

Tools accounted for

• Yes
• No
• N / A

Area cleaned up

• Yes
• No
• N / A

Completion Remarks: