Title Page

  • Area OSM name:

  • ALA/AIC name

  • Conducted on

  • Shift AM/ PM

  • Area: T4, T2, DC, PAD, or A-side

  • Gate, Service Road or Bagroom

  • Gate Number

  • MU Number

  • Gate, Service Road or Bagroom

  • Gate Number

  • PAD Number

  • Gate Number

  • Prepared by

TYPE OF OPERATION

  • What process is currently being observed?

  • What is being observed?

  • GSE number?

  • Additional information on observed improper lifting technique?

  • Aircraft tail number?

  • Agents present?

  • Attach a photo?

  • Water hose not retraced, not capped, or both?

  • Attach a photo?

  • Choose connected transporters or carts tongue, or towbar?

  • Choose Transporter or Cart?

  • Provide GSE Number

  • Is this equipment damaged?

  • Is this equipment being taking out of service?

  • Add photo

  • What type of PPE is missing?

  • Is the agent currently driving a GSE?

  • Additional notes?

  • Attach a photo?

  • What safe driving behavior that was observed?

  • What safe driving infraction was observed?

  • Attach a photo?

  • FOD observed at or on?

  • Provide GSE Number

  • Location of Make-up Unit

  • Attach a photo?

  • Choose Transporter or Cart?

  • What is damaged?

  • Provide GSE Number

  • Attach a photo?

  • What electronic device was being used?

  • Attach a photo?

  • Which Business partner?

  • Indicate what safety behavior was observed:

  • Attach photo

  • Is GSE/Vehicle inside safety zone?

  • Was the GSE/Vehicle facing the aircraft?

  • Choose: Missing Chocks, Handbrake down, or Unattended?

  • Provide GSE/Vehicle Number

  • Attach a photo?

  • What safety infraction was observed?

  • Attach a photo?

  • Flight Number:

  • Ship Number:

PROTECTIVE SAFETY EQUIPMENT

  • Are all agents wearing PPE? (Hearing Protection, Safety Vest, Steel Toe Shoes)

  • Which of the following PPE was observed missing?

  • Did you observe an agent(s) use their personal electronic devices in the operation?

  • Where electronic devices are being used?

PRE-ARRIVAL

  • Is the boarding bridge properly positioned for the specific type of aircraft and both wheels are in designated stow box?

  • Is the Safety zone clear? (Safety cone/nose gear chocks permitted to delineate stop line)

  • Were the agents observed clearing the area of FOD as they go?

ARRIVAL

  • Are wing walkers in position on the roadway, using proper hand signals and blocking the traffic?

  • Are wing walkers using a pair of working and approved wands (lit wands at night)?

  • Did agent placed a safety cone and/or nose gear chocks at the nose-gear stop point to assist with<br>designating aircraft stop point?

  • Are wing walkers following the path of the wing tips into the gate?

  • Was the aircraft parked utilizing (1) Marshaling Agent and (2) Wing Walkers?

  • Is this a B737-900 aircraft, MD88/90 or B717, or other mainline aircraft type?

  • Was tail-stand inserted before marshaling agent gave thumbs up to jet-bridge operator?

  • Did agent completely unloaded Bins 3 and 4, and wait 8 minutes from aircraft block in prior to unloading forward Bins 1/2? (Gates claims can be removed within 8 minutes)

  • Did marshaling agent give the all clear signal to the boarding bridge operator to move only after both main gears were chocked properly?

  • Did marshaling agent chock the nose gear immediately after giving the all clear signal to the boarding bridge operator?

  • Did marshaling agent provide chocks-in signal to the aircraft pilot? (After two sets of gear are chocked)

  • Are chocks placed parallel to the axle and lightly touching the centerline of the tire?

  • Wing walker agents observed off-loading only after chocking main gear?

OFF-LOAD

  • Is beltloader conveyor bed and handrail in the stowed position while approaching the aircraft?<br>

  • Did belt loader driver refrain from raising or lowering the conveyor belt while in motion?

  • Did the belt loader come to a complete stop prior to entering "No Drive Zone" (Safety Diamond) when approaching aircraft?

  • Did agents transition into/out of bins properly, by not riding belt loader or using conveyor bed as a lift?

  • Is the belt loader touching aircraft? (Beltloader driver didn't respect 2" clearance)

  • Is the belt loader positioned 8-10" above bin floor and not crossing door threshold?

  • Is the belt loader chocked properly (front and back of a straight tire)?

  • Is the belt loader chocked with the parking brake engaged during the entire unload process?

  • Type of aircraft been serviced: Narrow-Body (B757, B737, B717, MD88/90, or A319/320/321) or Wide-Body (B767, B777, A330, or A350)

  • What type of Narrow-Boddy is it?

  • At anytime did agents walk under the fuselage of the aircraft?

  • Is agent standing between beltloader and aircraft?

  • Is the belt loader handrail up while it is being used to unload specific aircraft type?

  • Which aircraft type is it?

  • Did agent use yellow stairs to open cargo door panel on wide-body aircraft type?

  • What did agent use to open cargo door panel in wide-body aircraft?

  • Did container loader (FMC) driver come to a complete stop prior to entering "No Drive Zone" (Safety Diamond) when approaching the aircraft?

  • Did container loader (FMC) clear of the cargo door swing area when opening the door?

  • Is container Loader touching aircraft?

  • Did agents avoid riding container loader platform as a lift?

  • Is tug driver agent using transporters with working locks?

  • Did transporters come in contact with the container loader (FMC) at any time?

  • Did the upper loading bridge of (FMC) have two guide bars properly positioned during unloading of ULD’s.

  • Did agent attempt to spin container (ULD) on upper bridge of FMC?

  • Baggage tug in neutral and parking brake engaged?

  • Did agents avoid operating or placing equipment within the 5 FT "No Drive Zone"?

  • Are agent body extremities inside of the bin?

  • Are bin webbings hanging outside of the bin during unload process?

  • GSEs staged back into their designated staging area after unloading is complete (Including Tail Tip Pole for B737-900)?

WALK - AROUND

  • Did the marshaling agent (or designated crew) begin walk around on 1st officer's side of the aircraft within 15 min of arrival?

  • Were the safety cones properly positioned around aircraft?

  • Did the marshaling agent connect the GPU and PCA?

  • Was the power-in signal given?

ARRIVAL

  • Is the area between gates clear from any GSE, Vehicles, or equipment prior to aircraft being marshalled-in?

  • Are the wing walkers in position on the roadway, using proper hand signals and blocking the traffic?

  • Are the wing walkers using a pair of correct and working wands (lit wands at night)?

  • Was the aircraft parked with (1) Marshaling Agent and (2) Wing Walkers?

  • Did marshaling agent chock the nose gear immediately after sending the all clear signal to the boarding bridge operator?

  • Did marshaling agent provide chocks-in signal? (After nose landing gear is chocked)

  • Are the main cabin door handrails lowered properly? (not stepping on the 1st step)

  • Are chocks placed parallel to the axle and lightly touching the centerline of the wheel?

  • Did the wing walker agents begin to off-load baggage after chocking main gear?

OFF-LOAD

  • Is the belt loader conveyor and handrail in the stowed position while approaching the aircraft?

  • Did belt loader driver avoid from raising or lowering the conveyor belt while in motion?

  • Did belt loader come to a complete stop prior to entering the "No Drive Zone" (Safety Diamond) when approaching the aircraft?

  • Did agents transition into/out of bins properly, by not riding belt loader or using conveyor as a lift?

  • Belt loader not touching aircraft (2" clearance between yellow bumper and door sill)?

  • Was the belt loader chocked properly (front and back of a straight tire)?

  • Did agent stand between belt loader and aircraft?

  • Agent body extremities are inside of bin?

  • Did agents avoid operating or placing equipment within the 5 FT "No Drive Zone"?

  • Were bin webbings hanging outside of the bin during load/unload process?

  • GSE staged back into a designated staging area after unloading is complete?

  • Did bag room driver drop off baggage cart between gates area?

  • Was the beltloader chocked with the parking brake engaged during the entire unload process?

WALK-AROUND

  • Did the marshaling agent (or designated crew) begin walking around on cargo bin side (Captain's side) of the aircraft within 15 min of arrival?

  • Were cones properly positioned by aircraft type? (Including Nose Cone for CRJ)

  • Does the aircraft have an INOP APU?

  • Did the marshaling agent connect the GPU prior to walking around on CRJ aircraft?

  • Was the PCA connected after the arrival walk around check and offload is completed?

  • Were the ground power and air applied immediately after the aircraft was chocked?

  • Was the GPU cord positioned behind NLG for all Delta Connection Aircraft?

  • Was the power-in signal given?

  • Is Delta Connection air panel secured?

  • At anytime did agents walk under the fuselage of DC aircraft?

  • At anytime did agents walk under the wing of DC aircraft? (Unless required to service the aircraft)

BOARDING BRIDGE OPERATION

  • Did jet bridge operator refrain from moving the bridge without receiving clearance from ramp personnel?

  • Did the jet bridge operator refrain from contacting the aircraft?

LOADING

  • Are chocks placed parallel to the axle and lightly touching the centerline of the tire?

  • Were the safety cones properly positioned around aircraft?

  • Is the belt loader conveyor bed and handrail in the stowed position while approaching the aircraft?

  • Did the belt loader driver refrain from raising or lowering the conveyor belt while in motion?

  • Did the belt loader come to a complete stop prior to entering the "No Drive Zone" (Safety Diamond) when approaching the aircraft?

  • Did agents transition into/out of bins properly, by not riding belt loader or using conveyor bed as a lift?

  • Is the belt loader touching aircraft (Agent didn't leave 2" clearance between belt loader yellow bumper and cargo door sill)?

  • Is the belt loader positioned 8-10" above bin floor and not crossing door threshold?

  • Is the belt loader chocked properly (front and back of a straight tire)?

  • Are bin webbings hanging outside of the bin during load process?

  • Are Agent's body extremities inside of bin?

  • Did agents avoid operating or placing equipment within the 5 FT "No Drive Zone"?

  • Baggage tug in neutral and parking brake engaged?

  • Is the belt loader chocked with parking brake engaged during the entire load process? Including jet bridge bags?

  • Did agents refrain from removing the belt loader with bed and/or handrail in a raised position?

  • Type of aircraft: Narrow-Body (B757, B737, B717, MD88/90, or A319/320/321) or Wide-Body (B767, A330, A350, or B777)

  • Is agent standing between belt loader and aircraft?

  • Did agents refrain from riding a moving belt or use belt loader conveyor bed as a lift?

  • Is this a B737-900 aircraft type?

  • Was the tail-tip-stand removed before agent started loading?

  • At anytime did agents walk under the fuselage of the aircraft? (Unless required to service the aircraft)

  • Is this a B717/MD88/MD90 aircraft type?

  • Did agents refrain from loading any bags (including gate checks bags) without the use of a belt loader in the aft bin?

  • At anytime did agents walk under the fuselage of the aircraft? (Unless required to service the aircraft)

  • Is this a A319/320/321 aircraft type?

  • Is the belt loader handrail up while it is being used to load bags and cargo into the bin?

  • Is there at least a 2" clearance between bags and cargo ceiling in Narrow-body Aircraft?

  • What aircraft type is it?

  • Did agent use yellow stairs to close cargo door bin for this aircraft type?

  • What did the agent use to close cargo door panel in wide-body aircraft?

  • Did Container loader driver come to a complete stop prior to entering "No Drive Zone" (Safety Diamond) when approaching the aircraft?

  • Is the container loader touching aircraft?

  • Did agents avoid riding the container loader platform as a lift?

  • Is the tug driver agent using transporters with working locks?

  • Did the transporters come in contact with the container loader at any time?

  • Did the upper loading bridge of (FMC) have two guide bars properly positioned during loading and unloading of ULD’s.

  • Did agent attempt to spin container (ULD) on upper bridge of FMC?

  • Did the container loader (FMC) clear of the cargo door swing area when closing the door?

  • Is the belt loader handrail up while it is being used to load bags and cargo into the bulk-bin?

  • Were all bins opened and checked?

FLIGHT CLOSE-OUT

  • Are two people (Wing-walker and Push-rig driver) used during tow-bar connection?

  • Is by-pass-pin being used on all aircraft (clip removed for MD-88/MD-90, B717)

  • Are bin webbing secured in all bins prior to departure?

  • Were GPU/Air conditioning disconnection communicated with Flight deck crew?

  • Was the departure walk around conducted?

  • Was the boarding bridge given clear signal (clear path) to move back?

  • Are the chocks removed only after tow-bar and tractor are hooked up to the aircraft and brakes are set (Headset or Face to Face)?

  • Did the ALA have a copy of the Load Report and Ramp Worksheet in his possession and have load report filled out accordingly?

  • Did agents made an attempt to clear area from FOD as they go?

PUSH-BACK

  • Is the safety zone clear of GSE prior to push-back?

  • Are wing walkers using a pair of correct working wands (lit wands at night)?

  • Are wing walker agents in position on the roadway, using proper hand signals and blocking the traffic?

  • Did the push-back driver push the aircraft at walking speed?

  • Is 3-points disconnect process being followed?

  • Did the marshaling agent wait until all equipment & personnel were clear of the aircraft's path to give the "All Clear" salute to the flight crew?

  • Did the crew return to the gate and prepare it for the next arrival (Cones, Chocks, Safety zone clear)?

LOADING

  • Did bag room driver drop off baggage cart between gates area?

  • Were cones properly positioned by aircraft type? (Including Nose Cone for CRJ)

  • Are chocks placed parallel to the axle and lightly touching the centerline of the wheel?

  • Was the GPU cord positioned behind NLG for all Delta Connection Aircraft?

  • Is the belt loader conveyor and handrail in the stowed position while approaching the aircraft?

  • Did belt loader driver avoid raising or lowering the conveyor belt while in motion?

  • Did belt loader come to a complete stop prior to entering the "No Drive Zone" (Safety Diamond) when approaching the aircraft?

  • Did agents transition into/out of bins properly, by not riding belt loader or using conveyor as a lift?

  • Belt loader not touching aircraft (2" clearance between yellow bumper and cargo door sill)?

  • Was the belt loader chocked properly (front and back of a straight tire)?

  • Did agent stand between belt loader and aircraft?

  • Agent body extremities are inside the bin?

  • Did agents avoid operating or placing equipment within the 5 FT "No Drive Zone"?

  • Were bin webbings hanging outside of the bin during load/unload process?

  • Baggage tug in neutral and parking brake engaged?

  • Was the beltloader chocked with parking brake engaged during the entire process including late bags and addition jet bridge bags?

FLIGHT CLOSE-OUT

  • Are bin webbing secured in all Bins prior to departure?

  • Are GPU/Air conditioning disconnection communicated with Flight deck crew?

  • Departure walk around conducted?

  • Is boarding bridge given clear signal (clear path) to move back?

  • Are the main cabin door handrails rised properly? (not stepping on the 1st step)

  • Are chocks removed only after tow-bar and tractor are hooked up to the aircraft and brakes are set (Headset or Face to Face)?

  • Did agents make an attempt to clear the area from FOD as they go?

  • At anytime did agents walk under the fuselage or the wing of the aircraft (Unless to service it)?

PUSH-BACK

  • Is safety zone clear of GSE prior to push-back?

  • Is the area between gates clear from any GSE, Vehicles, or equipment prior to push-back?

  • Are two people (Wing-walker and Push-rig driver) used during tow-bar connection?

  • Are wing walkers using a pair of correct working wands (lit wands at night)?

  • Wing walkers in position on the roadway, using proper hand signals and blocking the traffic?

  • Did the push-back driver push the aircraft at walking speed?

  • Is 3-points disconnect process being followed?

  • Did the marshaling agent wait until all equipment & personnel were clear of the aircraft's path to give the "All Clear" salute to the flight crew?

GENERAL BEHAVIOR

  • Did agent drive at walking speed around aircraft?

  • Were agents observed walking between connected conveyances or over towbar?

  • Was there unsecured and or unattended equipment observed pointing at the aircraft?

  • Provide GSE/Vehicle Number

  • Were the curtains closed on all carts and cans?

  • Were transporters and or carts observed with tongue down and not in locked position?

  • Agent refrains from pushing GSE with GSE.

  • Is agent using a seat belt while driving motorized equipment?

  • Did tug driver have bags stacked on tug?

  • Did driver keep extremities completely inside of the frame of the tug?

  • Did driver ensure all personnel clear of conveyances before start pulling away from the gate?

  • Is water hose retracted and capped?

MAKE-UP UNIT AREA

  • Are 1st Cart or transporter on the MU staged with tongue in lock position?

  • All GSEs not passing MU entrance or exit threshold?

  • Are locks functional and secured on all transporters?

  • Provide GSE number

  • Are MUs and conveyances clear of FOD?

  • Was agent(s) observed checking all conveyances for beyond limit damage?

EQUIPMENT OPERATED SAFETY

  • Did driver have bags on tug?

  • Are conveyance curtains secure prior to departing MU?

  • Did driver keep extremities completely inside of the frame of the tug?

  • Did the driver ensure all personnel cleared conveyances before pulling away from the pier?

  • Were there more than 4 Conveyances being hauled out of MU at a time?

  • Did you observe driver exceed walking speed in and or around MU area?

  • Did you observe the agent step over the tongue of the cart or transporter?

ERGONOMIC/OJI PREVENTION

  • Did agent lift item with 2 hands and keep the load close to body while lifting?

  • Was agent observed utilizing correct lifting techniques?

  • Did agent asks for help to lift heavy bags?

  • Did you observed agent(s) push/pull carts with elbows bent?

ADDITIONAL SAFETY CONCERN NEEDED TO BE REPORTED

  • Do you have any additional safety or process concerns that need to be reported?

  • Please describe your concern (s):

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