Information
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Employee Safety Observation
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Employee Name
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Employee ID
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Conducted on
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Uses three point stance when getting on and off forklift?
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Wears seat belt?
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Operates forklift in a safe manner?<br>(controls speed, keeps blades low to ground, looks before backing, etc.)
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Sets parking brake on forklift?
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Uses PPE when changing propane tank on forklift?
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Uses correct tool for job they are performing?
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Uses correct lifting techniques?
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Lifts with legs not back?
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Keeps back straight?
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Keeps load close to body?
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Does not twist body with load?
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Grips from separate corners of box?
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Does not enter trailer with chock on dock bumper?
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Wears proper footwear?
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Properly lowers/raises load racks inside trailer?
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Cleans, sweeps and picks up trash?
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Properly operates dock plate?
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Pushes pallet jack or dolly vs pulling?
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Overall practices safe work habits?
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Observer comments :
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Observer signature
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Employee comments:
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Employee signature
