Integrator Document — Control Block™ Platform
MACHINE
RISK ASSESSMENT
RISK ASSESSMENT
ISO 12100 · ISO 13849-1 · IEC 62061 · NFPA 79
Safety is the integrator's responsibility. This template provides the framework — you provide the machine-specific analysis.
Machine & Project Information
Machine Name
Machine Type / Function
Project / Work Order #
Customer / End User
Site / Facility
Serial Number (CB)
Assessment Date
Document RevisionRev 1
Prepared By
Reviewed By
Approved By
Applicable Standards
ISO 12100
ISO 13849-1
IEC 62061
OSHA 1910.212
NFPA 79
UL 508A
+ Add standard
Integrator / Manufacturer
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(PNG / JPG / SVG)
(PNG / JPG / SVG)
Company Name
Address
City / State / ZIP
Contact Name
Phone
Email
Website
Autoblocks Partner #
IMPORTANT: This document must be completed by a qualified safety engineer prior to commissioning any machine built on the Autoblocks Control Block™ platform.
The Control Block™ provides an integrated PLe / Category 4 / SIL3 safety architecture — however, the final system safety is the sole responsibility of the system integrator.
This template does not constitute a formal safety certification. All findings must be validated per ISO 13849-1 and/or IEC 62061 by a competent person.
autoblocks.co · info@autoblocks.co · 866-783-6148
Integrator Risk Assessment · Page 1
AUTOBLOCKS
Section 1–2 · Document Control & Machine Description
Machine: Machine Name
Rev 1 · 2026
Rev 1 · 2026
01 Document Control / Revision History
| Rev | Date | Author | Reviewed By | Description of Change | Actions |
|---|---|---|---|---|---|
| 1 | Initial issue | ||||
| 2 |
02 Machine Description / Intended Use
Control Block Configuration
| CB Model | |
| Firmware / SW Version | |
| Voltage Configuration | |
| I/O Config | |
| Number of Axes | |
| Absolute Motors Count | |
| Remote I/O Modules | |
| Robot Integration | None / EPSON / Universal Robots / Other |
| Vision System | None / Keyence / Cognex / Other |
Machine & Use Description
| Intended Use | |
| Foreseeable Misuse | |
| Operator Skill Level | |
| Operating Mode(s) | |
| Machine Speed / Force | |
| Parts / Materials Handled | |
| Production Rate | |
| Shift Pattern |
Machine / System Limits (ISO 12100 §5.3)
| Space Limits | Define the machine's total working envelope — safeguarded perimeter, max axis travel, robot reach, etc. |
| Time Limits | Design life, tool change intervals, periodic safety verification schedule, maintenance frequency. |
| Environmental Limits | Temperature range, IP rating of enclosure, EMI environment, vibration, ambient conditions. |
autoblocks.co · info@autoblocks.co · 866-783-6148
Page 2
AUTOBLOCKS
Section 3 · Hazard Identification & Risk Estimation
Machine: Machine Name
ISO 12100 Method
ISO 12100 Method
03 Hazard Identification / Risk Estimation
ISO 13849-1 Risk Graph Key
S: Severity — S1 Slight (reversible) · S2 Serious (irreversible/death) |
F: Frequency — F1 Seldom to infrequent · F2 Frequent to continuous |
P: Avoidance — P1 Possible · P2 Scarcely possible |
Required PL: PLa (lowest) → PLe (highest, provided by Control Block) |
CB Safety Rating: PLe / Category 4 / SIL3
Pre-populate with typical hazards below. Add machine-specific rows. Assign risk level BEFORE and AFTER controls. Delete rows that do not apply.
| # | Hazard / Source | Affected Person / Situation | S | F | P | Initial Risk | Safety Measures Applied | Residual Risk | Actions |
|---|---|---|---|---|---|---|---|---|---|
| Mechanical Hazards | |||||||||
| M1 | Crushing — linear actuator trapping hand/finger at end of stroke | Operator loading parts, maintenance | Very High / PLe | Light curtain on approach zone; door interlock on guard; E-stop at operator station; CB PLe safety controller cuts motor power. | Low / PLa | ||||
| M2 | Shearing — scissor point between moving carriage and fixed frame | Operator, maintenance | High / PLd | Fixed guards eliminating access; safety fencing with interlocked door; E-stop accessible from operator station. | Low / PLa | ||||
| M3 | Impact — unexpected axis motion striking operator or maintenance person | Operator, maintenance, setup | Very High / PLe | Safety fencing; light curtain; CB safety controller — E-stop deactivates all motor power via safety relay; controlled stop timeout configured; auto-restart prevention enabled. | Low / PLa | ||||
| M4 | Entanglement — rotating tooling, motor shaft, or lead screw | Operator, maintenance | Medium / PLc | Fixed guards over exposed shafts; LOTO procedure required before guard removal; Absolute Motors include integrated brakes that hold position on E-stop. | Low / PLa | ||||
| M5 | Stored energy — motor brake release after power loss / LOTO | Maintenance personnel | High / PLd | Mechanical gravity block or support fixture for vertical axes; LOTO procedure documented; Absolute Motors' integrated brakes engage on power loss. LOTO training required for all maintenance staff. | Low / PLa | ||||
| Electrical Hazards | |||||||||
| E1 | High-voltage shock — 120/240 VAC exposure inside CB enclosure | Maintenance, unauthorized access | High / PLd | CB enclosure is IP54 rated; lockable main disconnect required per NFPA 79; LOTO procedure; qualified personnel only per CB manual §3.7; opening CB voids warranty and requires authorized personnel only. | Low / PLa | ||||
| E2 | Low-voltage shock — 24 VDC bus terminals (10 terminals, 50W) | Maintenance, qualified integrator | Medium / PLb | 24V bus connections by qualified personnel only; overvoltage/short circuit/reverse polarity protection built into CB; LOTO before wiring; terminals labeled per NFPA 79. | Low / PLa | ||||
| E3 | Unexpected restart after power interruption or fault reset | Operator, maintenance in machine workspace | High / PLd | AutoCode program requires explicit operator RESET and START commands after E-stop or fault — no auto-restart. CB safety controller requires safety device reset before motion is re-enabled. Pendant E-stop must be physically released by operator. | Low / PLa | ||||
| Safety System Hazards | |||||||||
| SS1 | Safety device bypass — light curtain or door switch defeated during production | Any personnel in safeguarded space | Very High / PLe | CB Safety Settings screen restricted to Safety-level credentials; Test Mode (bypass) logs to audit trail; test mode disables automatically after configurable timeout; physical bypass of M12 safety device triggers fault; dual-channel wiring on all safety devices. | Low / PLa | ||||
| SS2 | Software/program fault causing unintended axis motion | Operator, nearby personnel | High / PLd | CB dedicated safety controller operates independently of AutoCode PLC — hardware E-stop path not software-dependent; real-time fault detection; safety I/O monitored each scan cycle; software changes require Safety-level credentials and re-commissioning validation. | Low / PLb | ||||
| Process / Application-Specific Hazards — Add Machine-Specific Rows Below | |||||||||
| P1 | Describe hazard here | Affected person | Describe safeguards applied | ||||||
| P2 | Ergonomic — awkward loading posture or heavy part handling | Operator | Medium / PLb | Workstation height adjustment; part assist fixtures or lift assists; operator training; weight limits labeled on any manual loading fixtures. | Low / PLa | ||||
autoblocks.co · info@autoblocks.co · 866-783-6148
Page 3
AUTOBLOCKS
Section 4 · Control Block Safety Architecture & Wiring Verification
Machine: Machine Name
PLe / Cat 4 / SIL3
PLe / Cat 4 / SIL3
04 Control Block Safety Architecture / Wiring
Control Block Built-In Safety Rating
PLe / Category 4 / SIL3 — The Control Block's integrated safety controller and safety relay cut motor power on any E-stop or safety device fault.
All safety devices connect via M12 connectors with dual-channel N.C. wiring. The Safety Configuration screen (Settings → Safety Settings) requires Safety-level credentials to modify.
Safety I/O capacity: 54 channels. Controlled stop timeout is configurable (0 ms = immediate cut).
Wiring diagrams available to authorized integrators upon request from Autoblocks.
Safety Device Wiring Checklist
Complete this table for each safety device installed on the machine. Verify wiring, port assignment, AutoCode mapping, and function test before commissioning.
| ID | Safety Device | CB Port / Connector | Wiring Type | AutoCode Safety Mapping | Installed / Model | Tested ✓ | Notes |
|---|---|---|---|---|---|---|---|
| SD1 | Pendant E-Stop Built-in, DB15 port |
DB15 — front panel | N.C. dual-channel (integrated) | Safety Device 1 — Teach Pendant E-Stop | Autoblocks Pendant (integrated) | ||
| SD2 | Remote E-Stop Field-wired |
M12 — rear panel (dedicated E-stop port) | N.C. dual-channel | Safety Device 2 — Remote E-Stop | Vendor / Model | ||
| SD3 | Light Curtain TX | M12 — LC Transmitter port | N.C. OSSD dual-channel | Safety Device 3 — Light Curtain | Keyence GL-R / Other | ||
| SD4 | Light Curtain RX | M12 — LC Receiver port | N.C. OSSD dual-channel | Safety Device 3 — Light Curtain (pair) | Keyence GL-R / Other | ||
| SD5 | Door Interlock 1 Daisy-chain port — up to 8 total |
M12 — Door interlock port (daisy-chain) | N.C. dual-channel, daisy-chain | Safety Device 4 — Door Switch | Keyence GS / Other | ||
| SD6 | Door Interlock 2 (repeat SD5 row for each additional door, up to 8 total) |
M12 — daisy-chained from SD5 | N.C. dual-channel | Safety Device 4 — Door Switch (chain) | Keyence GS / Other / N/A | ||
| SD7 | Light Tower | M12 — light tower port | Output (PNP, 3-color) | System status output — Red/Yellow/Green per AutoCode state | Banner EZ-Light / Other | ||
| SD8 | Additional safety device | Port | N.C. / OSSD | AutoCode mapping | Vendor / Model |
Safety Configuration Screen Verification (Settings → Safety Settings)
Pendant E-Stop toggle — set to ENABLED (green) in production mode
Remote E-Stop toggle — set to ENABLED (green) in production mode
Door Switch(es) toggle — set to ENABLED (green) in production mode
Light Curtain toggle — set to ENABLED (green) in production mode
Test Mode — confirmed DISABLED prior to handover; test mode use logged to audit trail
Safety IO Hidden — set appropriately for operator-facing deployment
Controlled Stop Timeout — configured: ___ ms (0 ms = immediate cut; increase only if controlled decel required)
Safety credentials — Safety Settings screen locked to Safety-level password. Password documented in secure location
Safety modifications reviewed — any change to safety wiring or logic reviewed by a qualified safety engineer per CB manual §3.8
Fault log reviewed — no pre-existing safety faults in CB audit log at time of commissioning
Wiring diagrams on file — CB wiring diagrams requested from Autoblocks and filed with this assessment
LOTO procedure documented — machine-specific LOTO procedure completed and posted at machine (see Section 6)
Motor Safety — Absolute Motors (if applicable)
Motor count verified — __ motors connected (max 10 per system via Custom CAN bus)
Topology documented — daisy-chain and/or home-run from CB's 4 rear M12 motor ports: describe topology
Integrated brakes verified — where installed, brakes engage on E-stop / power loss (no backdriving)
Axis type configured — each axis set as Linear or Rotary in AutoCode; gear ratio entered per axis
Vertical axis gravity support — mechanical gravity block or counterbalance installed for any vertical axis
Single M12 cable per motor — correct M12 cable routing, no exposed conductors, strain relief installed
autoblocks.co · info@autoblocks.co · 866-783-6148
Page 4
AUTOBLOCKS
Section 5–7 · Safety Circuit Tests · LOTO · Residual Risk
Machine: Machine Name
Pre-Commissioning Verification
Pre-Commissioning Verification
05 Safety Circuit Verification Tests
All tests must be performed before handover to the customer. Record tester name and date. Failures must be resolved and re-tested.
| # | Test Description | Expected Result | Pass / Fail | Tested By | Date | Notes |
|---|---|---|---|---|---|---|
| T1 | Actuate Pendant E-Stop during machine run cycle | All motor power cut immediately; motion stops; light tower → Red; CB fault log entry created | ||||
| T2 | Actuate Remote E-Stop button during machine run cycle | Same as T1; motor power cut; program halts; operator must physically release and issue RESET to restart | ||||
| T3 | Interrupt light curtain beam during machine auto cycle | Machine stops immediately; light tower → Red; auto-restart does NOT occur; operator must RESET and START | ||||
| T4 | Open interlocked guard door during machine auto cycle | Machine stops immediately; door switch fault logged; machine will not restart until door closed, safety reset, and operator START | ||||
| T5 | Attempt to start machine with light curtain beam interrupted (blocked) | Machine will not start; CB displays light curtain fault; operator cannot bypass without Safety-level credentials | ||||
| T6 | Power-cycle CB — verify machine does NOT auto-restart | Machine powers up in STOPPED state; operator must issue START command; no axis movement on power-up | ||||
| T7 | Verify light tower states: Running → Green, Faulted/E-stop → Red, Idle/Ready → Yellow | All three states confirmed visual and/or audible as configured in AutoCode | ||||
| T8 | Verify integrated motor brakes hold position on E-stop (vertical axes) | Vertical axes do not back-drive after E-stop; brakes engage within configured stop timeout | ||||
| T9 | Verify safety audit log records E-stop and safety fault events | CB HMI safety log shows timestamps and device IDs for all T1–T8 events triggered above | ||||
| T10 | Machine-specific test — describe | Expected result |
06 Lockout / Tagout (LOTO) Procedure Summary
Energy Sources to Isolate
120/240 VAC — main power disconnect (lockable) — location: describe
24 VDC bus — de-energized when main disconnect opened
Pneumatic (if applicable) — isolation valve location: N/A or describe
Stored mechanical energy — gravity support fixtures in place for vertical axes
All energy sources verified ZERO prior to opening any enclosure or entering safeguarded space
LOTO Document Location & Training
LOTO Procedure DocPosted at machine / File location
Lockout Device Location
LOTO Training RecordsFile location
All maintenance personnel trained on machine-specific LOTO procedure
LOTO tags and locks available at machine station
07 Residual Risk Summary & Acceptance Statement
Residual Risks After All Safeguards Applied
List any residual risks that remain after all engineering controls, safeguards, and procedures have been implemented. These must be documented, communicated to the customer, and addressed through training and PPE.
| Hazard Ref. | Residual Risk Description | Risk Level | Mitigation / Warning Provided |
|---|---|---|---|
| e.g. M3 | Describe residual risk | Low | Operator training, warning label on machine, PPE requirement |
Acceptance Statement
The undersigned qualified safety engineer confirms that a formal risk assessment has been conducted in accordance with ISO 12100 for this machine.
All identified hazards have been reduced to acceptable levels using the three-step method (inherent design → safeguarding → information for use).
Residual risks are documented above and have been communicated to the end user.
The machine is considered safe for handover subject to completion of all verification tests in Section 5 and operator training.
autoblocks.co · info@autoblocks.co · 866-783-6148
Page 5
AUTOBLOCKS
Section 8 · Operator Training & Sign-Off
Machine: Machine Name
Commissioning Handover
Commissioning Handover
08 Operator Training & Pre-Handover Checklist
Operator Training Confirmed
E-Stop location and operation — pendant + all remote E-stops demonstrated to operators
Safety device function — light curtain, door interlocks, light tower states explained
Normal start / stop sequence — operator can correctly start and stop machine
Fault acknowledgment and reset — operator can read CB fault screen and perform safe reset
No unauthorized modifications — operators instructed not to modify AutoCode, safety settings, or wiring
Maintenance LOTO — maintenance personnel trained on machine LOTO procedure
CB Manual provided — Control Block Manual (current version) provided to customer
Autoblocks support contact provided — info@autoblocks.co · 866-783-6148
Risk assessment copy provided to customer — signed copy filed with machine documentation
Safety label placement verified — all required labels installed per ANSI Z535 / OSHA requirements
Final Pre-Commissioning Checks
All safety circuit tests (Section 5) passed — no open failures
Safety device wiring table (Section 4) fully completed and verified
CB Safety Settings screen — all devices ENABLED, Test Mode DISABLED
CB firmware and AutoCode version documented (Section 2)
All guards, covers, and enclosure panels installed and fastened
Machine grounding and bonding verified per NFPA 79
Cable management complete — no pinch points, adequate flex relief
Wiring diagrams, this RA document, and CB manual archived in project folder
Periodic safety inspection schedule communicated to customer (recommended: monthly safety device function test)
Autoblocks partner acknowledgment — integrator confirms they are a qualified Autoblocks partner
09 Sign-Off / Authorization
Prepared By — Safety Engineer
Name
Title
Company
Signature
Date
Reviewed & Approved By
Name
Title
Company
Signature
Date
Customer / End User Acceptance
Name
Title
Company
Signature
Date
Integrator Contact Information (for warranty and support)
Integrator Company
Contact Person
Phone
Email
Address
Support Hours
Emergency Contact
CB Warranty Contactautoblocks.co · 866-783-6148
Autoblocks Support
autoblocks.co
Autoblocks, Inc.
333 Route 46 W, Building B · Fairfield, NJ 07004
autoblocks.co · info@autoblocks.co · 866-783-6148
333 Route 46 W, Building B · Fairfield, NJ 07004
autoblocks.co · info@autoblocks.co · 866-783-6148
autoblocks.co · info@autoblocks.co · 866-783-6148
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