Safety Orientation Module-General Industry

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Your Company NameKindly make sure your spelling is correct.
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Inspector NamePlease enter only your first and last name exactly as it appears in your employer’s official records. Do not include middle names or additional surnames.
First Name
Last Name
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Your EmailPlease enter your work email or the email address you provided on your employment application with your current employer. Your personal training record will be sent to this email, so please ensure it is spelled correctly.
example@example.com
Email Verified
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Please check your mailbox and paste the code below to complete verification
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Purpose:
The purpose of this inspection form is to ensure that all dies used in punch press operations are inspected prior to use for cracks, wear, misalignment, or other defects that could compromise safety or performance. This inspection supports compliance with OSHA 29 CFR 1910.212 and 1910.217 and ensures that defective or damaged dies are removed from service immediately to prevent equipment failure, injuries, or production delays.
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Date of Inspection
Date
Year
Month
Day
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Machine ID
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Die ID
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Visual Inspection
Satisfied
Not Satisfied
Notes
1. No cracks or fractures visible
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2. No chipping or deformation
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
3. No signs of excessive wear
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
4. No sharp edges or burrs
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
5. Die properly seated and aligned in press
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
1. No cracks or fractures visible
2. No chipping or deformation
3. No signs of excessive wear
4. No sharp edges or burrs
5. Die properly seated and aligned in press
Satisfied
Row 0, Column 0
Not Satisfied
Row 0, Column 1
Notes
Row 0, Column 2
Satisfied
Row 1, Column 0
Not Satisfied
Row 1, Column 1
Notes
Row 1, Column 2
Satisfied
Row 2, Column 0
Not Satisfied
Row 2, Column 1
Notes
Row 2, Column 2
Satisfied
Row 3, Column 0
Not Satisfied
Row 3, Column 1
Notes
Row 3, Column 2
Satisfied
Row 4, Column 0
Not Satisfied
Row 4, Column 1
Notes
Row 4, Column 2
1 of 5
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Functional Checks
Satisfied
Not Satisfied
Notes
1. Die is securely fastened in place
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2. Correct die for the job is installed
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
3. Alignment checked and confirmed
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
4. Press controls, guards, and interlocks tested and operational
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
5. No unusual vibration, noise, or movement when cycling
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
1. Die is securely fastened in place
2. Correct die for the job is installed
3. Alignment checked and confirmed
4. Press controls, guards, and interlocks tested and operational
5. No unusual vibration, noise, or movement when cycling
Satisfied
Row 0, Column 0
Not Satisfied
Row 0, Column 1
Notes
Row 0, Column 2
Satisfied
Row 1, Column 0
Not Satisfied
Row 1, Column 1
Notes
Row 1, Column 2
Satisfied
Row 2, Column 0
Not Satisfied
Row 2, Column 1
Notes
Row 2, Column 2
Satisfied
Row 3, Column 0
Not Satisfied
Row 3, Column 1
Notes
Row 3, Column 2
Satisfied
Row 4, Column 0
Not Satisfied
Row 4, Column 1
Notes
Row 4, Column 2
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Condition Status
Please Select
Please Select
Acceptable
Needs Maintenance
Remove from Service
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Corrective Actions TakenOnly required if corrective actions were taken!
Huge
Large
Normal
Small
Ok
Ok
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SignatureBy signing below, I certify that I have completed this die inspection, recorded all findings accurately, and that any defects or unsafe conditions identified have been reported in accordance with company procedures and OSHA requirements.
Should be Empty: