Press Brake Guarding Information Form

Customer

Address (location of machine(s))

City

State

Zip

Location / GPS

Contact Name

Contact Phone Number

Contact Phone Email *

Hours able to work: Monday-Friday

Hours able to work: Saturday

Hours able to work: Sunday

Is a company sponsored safety orientation course required for OUR crew?

YesNoN/A

Press brakes

Press brake 1

Manufacturer

Model

Serial Number

Photo of Machine Nameplate

Photo of Machine Front

Photo of Machine Left

Photo of Machine Right

Photo of Machine Backside

Max Upper Punch Height

Is the Back Gauge Automatic or Manual?

AUTOMANUAL

Schematics available?

YesNo

Bed Length (inches)

Is there an existing safety system / device to be removed?

YesNo

Photos of Existing Safety System (if applicable)

Are there any mechanical, electrical or other problems with the machine? (When we arrive, the machine must be operating according to the original OEM design & specification. Addition trip charges could occur if machine(s) are in need of repair!!)

YesNo

Comments (Note any problems)

Is work completed / formed off / beyond the end of press brake?

YesNo

Are multi-height die set ups used TOGETHER. (SAME SET-UP & more than one bending plane)

YesNo

If Yes what percentage of machine run time?

Does brake have horn?

YesNo

If yes 1 end or 2?

Is the TALLEST upper die, including the tang, taller than 11"?

YesNo

Please check the quantity of each Foot Switches

Is there a RAM UP or RAM DOWN control somewhere on the machine allowing the ram or tooling to reverse direction in case of entrapment?

YesNo

Enter the measured ID (inches) frame to frame walls on backside (for barrier guard on back)

Is there any clearance needed to “get beyond” the back gauge or cover any possible gaps (for barrier guard on back)?

YesNo

If Yes what is the total dimensions (inches) needed to guard the back (explain)?

Please check the quantity of each Treadle Bar

Press Brake Machine Information