Title Page
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Conducted on
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Prepared by
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Location
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Time and Date of Audit
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1. Did you initiate audit from a different direction than you last audit?
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What area did you initiate the audit from? EX: Mercedes, C Dock, Front Break Room, etc...
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2. To your knowledge has operator been trained to the BGM lift truck safety program and contractor zero tolerance policy? If not remove from lift and conduct immediately.
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3. Is operator wearing seat belt? If not, remove from lift and property.
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4. Is operator wearing ear plugs? If not, remove from lift a property.
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5. Is operator wearing safety glasses? If not, remove from lift and property.
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6. Is operator wearing safety shoes? If not, remove from lift and property.
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7. When met in drive aisle by a another lift does BSCS operator stop to allow them around? You need to observe until witnessed yes or no.
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8. Did BSCS operator cross into pedestrian walkway with lift or load?
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9. Does operator travel backwards while their view is obstructed?
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10. Does operator drive at or under the 7 mph speed limit for the building?
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11. Does operator use horn in needed areas?
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12. Does operator keep load 4-6" from ground while traveling?
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13. Is operator eating or drinking while operating the lift?
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14. Is operator using a cell phone for ANY reason while forklift is turned on? If so, remove from lift and property.
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15. Pick on forklift safety key point to discuss with operator. List topic and notes from conversation.
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Name of person being audited
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Name of person doing audit
