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[Link]/MachineRiskAssessment
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Machine Risk Assessment 12/26/2024
Equipment: Mold Press RD-437 BRT-NXC Assessment Team Members Start Date: [Date] Accident follow up? Yes or No
Location: Manufacturing B Team Lead: Jannet Wells
[Names here]
Note: This free risk assessment spreadsheet is intended for basic applications in the United States. This should not be used for
robotics, large or complex machinery, or international compliance requirements. Contact UL for risk assessments for robotics Members:
or applications that are beyond the scope of this tool.
Contact UL for more information: [Link]/MachineRiskAssessment, email: FactoryServices@[Link], 1-877-UL-HELPS
Instruction: Please follow Risk Assessment Steps below. Use Risk Assessment Flow Chart and Risk Factor Definitions.
Risk Level: 1–8 Represents Low Level 9–14 Represents Medium Level 15–20 Represents High Level
Risk Level Estimate Method of Reduction Final Risk Estimate
Date Final
Task #
Frequency of Probability of Injury Severity of Injury Number of People Protracted time in Safe- Admin. Frequency of Probability of Injury Severity of Injury Number of People Protracted time in
Task Affected Persons Hazard Type Exposure 1,2,4 1,2,4,6 1,3,6,10 Exposed Danger Zone
Est. Risk Level Tolerable? Design Method description Follow-up Owner Exposure 1,2,4 1,2,4,6 1,3,6,10 Exposed Danger Zone
Final Risk Level Tolerable? Notes
guarding Controls
Assessment
Normal Operation
1 Open guard to load or unload Operator / Helper 10.1 - Failure/disorder of the control system Add safety rated switch and control reliable
materials. Guard interlock switch stopping circuit. Ensure all guards comply
not safety rated. Circuit not control 4 4 10 1 0 18 No X X with OSHA/ANSI guard openings. E-Stop 12/31/2019 J. Wells 1 1 6 1 0 8 Yes
reliable. accessible.
2 During production, operator cleans Materials Handler 1.1 - Crushing hazard Light curtain detects operator presence and
excess material off press. is wired into a Control Reliable stopping
circuit. Control Reliable circuit includes
functional safety rated components,
4 2 6 1 0 12 No X X redundant wiring, monitoring, and redundant 12/31/2019 J. Wells 4 1 3 1 0 8 Yes
final switching elements. E-Stop is
provided. Operator uses a tool to clean.
Validated by 3rd party.
0 Yes 0 Yes
Maintenance Activities
3 Replace hydraulic cylinder. Maintenance 1.9 - High pressure fluid injection or ejection Use LOTO procedures to ensure all energy
Personnel hazard 1 6 10 1 1 18 No X is removed. 12/31/2019 J. Wells 0 0 0 1 1 1 Yes
Commissioning/Other
4 N/A - Machine already installed. 0 Yes 0 Yes
5 Plant Visitors are not allowed
close to machine. Supervisors 0 Yes 0 Yes
are trained operators.
Contact UL for additional information:
[Link]/MachineRiskAssessment
FactoryServices@[Link]
1-877-UL-HELPS
Copyright© 2019 UL LLC. All rights reserved.
[Link] Example RA Form Page 3 of 12
Machine Risk Assessment 12/26/2024
Equipment: [Machine Name here] [Machine # here] [Other ID here] Assessment Team Members Start Date: [Date] Accident follow up? Yes or No
Location: [Building Name here] Team Lead: [Name here]
[Names here]
Note: This free risk assessment spreadsheet is intended for basic applications in the United States. This should not be used for robotics,
large or complex machinery, or international compliance requirements. Contact UL for risk assessments for robotics or applications that are Members:
beyond the scope of this tool.
Contact UL for more information: [Link]/MachineRiskAssessment, email: FactoryServices@[Link], 1-877-UL-HELPS
Instruction: Please follow Risk Assessment Steps below. Use Risk Assessment Flow Chart and Risk Factor Definitions.
Risk Level: 1–8 Represents Low Level 9–14 Represents Medium Level 15–20 Represents High Level
Risk Level Estimate Method of Reduction Final Risk Estimate
Task #
Affected Frequency of Probability of Injury Severity of Injury Number of People Protracted time in Safe- Admin. Date Final Follow- Frequency of Probability of Injury Severity of Injury Number of People Protracted time in
Task Hazard Type Est. Risk Level Tolerable? Design Method description Owner Final Risk Level Tolerable? Notes
Persons Exposure 1,2,4 1,2,4,6 1,3,6,10 Exposed Danger Zone guarding Controls up Assessment Exposure 1,2,4 1,2,4,6 1,3,6,10 Exposed Danger Zone
Normal Operation
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
Maintenance Activities
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
Commissioning/Other
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
0 Yes 0 Yes
Steps to Conduct Risk Assessment
1. Identify tasks done by operator that expose operator to hazard
2. Identify hazards of that task
3. Categorize hazard type - header comment box identifies possible hazard types (right click to show/hide comment); cell dropdown may be used for selection
4. Enter frequency value - use cell comment box and dropdown values
5. Enter probability value - use cell comment box and dropdown values
6. Enter severity value - use cell comment box and dropdown values
7. Enter number of people exposed to that hazard at the same time
8. Enter value for protracted time in danger zone - use header comment box for values
9. Risk level will be calculated
10. Repeat steps 2-9 for all tasks
11. If risk value is >8 for any task then continue to step #12 for each
12. Identify method of reduction - select design, safeguarding and/or administrative controls and provide brief description
13. Recalculate risk score (steps 4-8) with reduction method in place
14. Repeat process (steps 1-13) for Maintenance tasks and for Visitors or other hazard exposure
Contact UL for additional information:
[Link]/MachineRiskAssessment
FactoryServices@[Link]
1-877-UL-HELPS
Copyright© 2019 UL LLC. All rights reserved.
[Link] RA Form Page 4 of 12
Safe Guarding Program
Risk Factor Definitions
Estimated Risk Value = Frequency + Probability + Protracted Time + (Severity x # of People Exposed)
Frequency of Exposure
Value Factor Definition
1 Seldom May Possibly occur during an eight (8) hour shift
2 Occasional Will occur during an eight (8) hour shift
4 Frequent Will occur more than four times in an eight (8) hour shift!
Probability of Injury
Value Factor Definition
1 Unlikely When exposed to the hazard, an injury is easily avoided.
2 Possible When exposed to the hazard, an injury can be avoided.
4 Probable When exposed to the hazard, an injury is unlikely to be avoided.
6 Certain When exposed to the hazard, an injury cannot be avoided.
Protracted Time
Value Factor Definition
0 Short Duration Less than 15 minutes
1 Protracted Greater than 15 minutes
Severity
Value Factor Definition
1 Minor No/slight injury requiring no more than first aid (little or no lost work time)
3 Serious Significant injury/illness requiring more than first aid (able to return to same job)
6 Major Severe debilitating injury/illness (able to return to work at some point)
10 Fatal Death or Permanently disabling injury (unable to return to work)
Risk Value Scale: 1–8 Represents Low Level, 9–14 Represents Medium Level, 15–20 Represents High Level
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Contact UL for additional information:
[Link]/MachineRiskAssessment
FactoryServices@[Link]
Page 5 Risk Assessment Spreadsheet
Safe Guarding Program
Risk Factor Definitions
1-877-UL-HELPS
Copyright© 2019 UL LLC. All rights reserved.
Page 6 Risk Assessment Spreadsheet
Safe Guarding Program
Risk Factor Definitions
Page 7 Risk Assessment Spreadsheet
Start
Risk Assessment Flow Chart
Identification of Machine
Risk Reduction
By Design
Re-evaluate Can
Change Material Substances,
Machine Limits the Hazard
Reduce energy, Reduce
be eliminated or YES
Can you foresee all occurrence of the task or
possible operation and risk reduced hazard, Modify physical,
use of the machine? by design? features!
Task/Hazard
Identification NO
Risk Reduction
Risk Estimation Can By Guarding
the risk be Improved guarding, Control
reduced by Safe YES Systems, Protective devices,
YES etc. In accordance with B11
Guarding,
protective standards!
Has a devices?
Do other tolerable risk
Tasks/Hazards YES NO
been
Exist? achieved?
NO
Risk Reduction By
Can Administrative Controls
NO
the risk be Warnings, Alarms, Instruction
reduced by Manuals, Safe work practices,
File Documentation Administrative controls YES Training, Personal protective
other measures equipment, Supervision, etc.
Procedures?
Done!
NO
Page 8
Contact UL for additional information:
[Link]/MachineRiskAssessment
FactoryServices@[Link]
1-877-UL-HELPS
Copyright© 2019 UL LLC. All rights reserved.
Page 9
Liability Disclaimer
By making use of any information in this Risk Assessment Workbook or Spreadsheet ("Spreadsheet"), you
NO WARRANTIES: All of the information provided on this Spreadsheet is provided "AS-IS" and with NO W
including for example implied warranties of merchantability or fitness for a particular purpose, are made wi
on this site. UL LLC, makes no representations and extends no warranties of any type as to the accuracy o
Spreadsheet.
DISCLAIMER OF LIABILITY: UL LLC specifically DISCLAIMS LIABILITY FOR INCIDENTAL OR CONSEQ
liability for any loss or damage suffered by any person as a result of the use or misuse of any of the inform
undertakes NO LIABILITY for any loss or damage suffered as a result of the use, misuse or reliance on the
USE AT YOUR OWN RISK: This Spreadsheet is for informational purposes only. Consult a licensed engin
or mitigations, including use of information in this Spreadsheet. It is your responsibility to evaluate your ow
determine whether to perform, use or adapt any of the information or content on this Spreadsheet. All mac
In no event shall our company be liable for any direct, indirect, punitive, incidental, special consequential d
connected with the use or misuse of this Spreadsheet or information contained herein.
Contact UL for additional information:
[Link]/MachineRiskAssessment
FactoryServices@[Link]
1-877-UL-HELPS
Copyright© 2019 UL LLC. All rights reserved.