BI logistics

• Conducted on

  Date

• Prepared by

• Building

• Date/Time

  Date

• Employee name

• Task being completed.

PPE

• Are they wearing proper foot protection (safety shoes)?

  Yes

  No

  N/A

• Are they wearing the proper hand protection?

  Yes

  No

  N/A

• Are they wearing the proper eye protection?

  Yes

  No

  N/A

Equipment usage

• Mobile Equipment- was it inspected before use?

  Yes

  No

  N/A

• Forklift- was operator checklist completed before use?

  Yes

  No

  N/A

• Forklift - was forklift operated safely?<br>

  Yes

  No

  N/A

• Vehicle operation - was operator checklist completed before use?

  Yes

  No

  N/A

• Vehicle operation - was vehicle operated safely?

  Yes

  No

  N/A

• Tools - was tool inspected before use?

  Yes

  No

  N/A

• Tools - was tool used correctly?<br>

  Yes

  No

  N/A

Ergonomics

• Lifting/carrying/pulling/pushing:<br>Body movement

  Yes

  No

  N/A

JRR

• Was JSA reviewed prior to completing task?

  Yes

  No

  N/A

• Was Take 5 completed before completing task?

  Yes

  No

  N/A