ACSC Perfect Practice Observation

• Conducted on

  Date

• Prepared by

• Location
  Address

Forklift Safety Item Observed

• Operators Name

• Please take pictures and add them to the questions as media as you complete this perfect practice observation. For any item not marked "yes" please provide appropriate follow up plans on the question.

• Forklift operator comes to a complete stop at intersections?

  Yes

  No

  N/A

• Forklift operator is "intentional" in their awareness at an intersection? Meaning- You see their head look left, right, and up to the mirror prior to proceeding.

  Yes

  No

  N/A

• Forklift operator sounds horn prior to taking off from stop at intersection

  Yes

  No

  N/A

• Did you observe at least 5 instances where the forklift operator navigated an intersection?

  Yes

  No

  N/A

• Forklift operator squares forklift with the load and proceeds forward slowly completely under the load?

  Yes

  No

  N/A

• Forklift operator does not lift or lower forks while forklift is in motion except for when needed due to space constraints?

  Yes

  No

  N/A

• Forklift operator lifts load 2-6 inches off of the ground and tilts the load back towards the lift.

  Yes

  No

  N/A

• Forklift operator visually checks to left and right side of load to ensure clearance before traveling in reverse?

  Yes

  No

  N/A

• Forklift operator honks horn and proceeds slowly traveling in reverse?

  Yes

  No

  N/A

• When going to stack the load, operator squares up to the current stack before lifting?

  Yes

  No

  N/A

• Forklift operator proceeds forward slowly toward the current stack and stops about one foot from the stack?

  Yes

  No

  N/A

• Forklift operator does not start to lift the load until wheels are stopped?

  Yes

  No

  N/A

• Forklift operator lifts load to desired height in order to stack?

  Yes

  No

  N/A

• Forklift operator looks to left and right side of load to ensure clearance and proceeds forward slowly?

  Yes

  No

  N/A

• Forklift operator lowers load slowly and evenly stacking on top of desired spot?

  Yes

  No

  N/A

• Forklift operator visually checks to left and right side of load to ensure clearance and before traveling in reverse?

  Yes

  No

  N/A

• Forklift operator honks horn and proceeds slowly traveling in reverse?

  Yes

  No

  N/A

• Forklift operator tilts all loads back to help stabilize the load before any travel forward or reverse?

  Yes

  No

  N/A

• Forklift operator does not lift and lower forks loaded or unloaded while in motion at anytime?

  Yes

  No

  N/A

• Forklift operator travels with all loads 3"-5" from ground to prevent spilling the load

  Yes

  No

  N/A

• Forklift operator uses 3 points of contact getting on and off the forklift?

  Yes

  No

  N/A

• Operator does not move the lift until their seat belt is fastened?

  Yes

  No

  N/A

• Operator wears proper PPE in the correct fashion? ie. No backwards bump caps, proper shoes, vest

  Yes

  No

  N/A

• Operator completed pre-use inspections on lift prior to operating?

  Yes

  No

  N/A

• Operator Signature

  Sign

• Observer Signature

  Sign

• Please keep in mind we should always be looking for ways to improve every operator. Think of some things you are going to be working on with this operator even if they were 100% on this observation. Make some calendar events to help with follow up efforts in Making Better our operators and operation!