Bluegrass Forklift Initial Safety Observation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Before Operations

• Pre-use inspection discussed and candidate understands or can already complete?

  Yes

  No

  N/A

• PPE discussed and worn properly?

  Yes

  No

  N/A

• Candidated can read and understand ID plate?

  Yes

  No

  N/A

• Does operator know the load capacity?

  Yes

  No

  N/A

Getting on and off the forklift

• Operator uses 3 point contact when getting on and off the forklift?

  Yes

  No

  N/A

• Forks are lowered and placed on the floor when leaving the forklift?

  Yes

  No

  N/A

• Parking brake is always set before leaving forklift?

  Yes

  No

  N/A

• Forklift is switched off and key is maintained in the specified place when ending operations?

  Yes

  No

  N/A

Forklift Operations

• Forklift path is checked for any personnel or obstacles before proceeding on the forklift?

  Yes

  No

  N/A

• Quick starts or quick stops are not performed?

  Yes

  No

  N/A

• Specified speed limit is followed? (6mph or less)

  Yes

  No

  N/A

• Material has been checked for any damages and unstable stacks?

  Yes

  No

  N/A

• Loads on the pallet are transported after confirming that the load is stacked safely and in stable condition?

  Yes

  No

  N/A

• Forklift is paused and position of the forks is confirmed before inserting forks?

  Yes

  No

  N/A

• Forks are positioned in the pallet properly?

  Yes

  No

  N/A

• Loads are lowered correctly?

  Yes

  No

  N/A

• Forklift is not driven with loads higher than 2 to 4 inches from the surface?

  Yes

  No

  N/A

• The forklift mast is tilted back to maintain loads during operations?

  Yes

  No

  N/A

• The operator drives in reverse when the view is obstructed?

  Yes

  No

  N/A

• Operator stops and sounds horn at intersection?

  Yes

  No

  N/A

Loading and Unloading

• All dock constraints are discussed if applicable and candidate understands how to use during the loading / unloading process?

  Yes

  No

  N/A

• General Comments and/or follow ups that may be needed for consideration of employement

• Candidate Signature

  Sign

• Observed By

  Sign