breadsolutions ELECTRIC PALLET JACK COMPETENCY checklist

• Audit Title

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• Yes

  No

  N/A

• Conducted on

  Date

• Select date

  Date

SAFETY INSPECTIONS

• Completes pre-operational safety inspection & checklist

  Yes

  No

  N/A

• Knows steps in reporting faulty/unsafe equipment

  Yes

  No

  N/A

LOAD - PICK UP

• Adheres to safety rules of site in travel (uses horn at intersections/near other MHE, comes to complete stop at int., etc..)

  Yes

  No

  N/A

• Checks for hazards (pedestrians other MHE) prior to moving off via shoulder checks

  Yes

  No

  N/A

• Checks pallet & load for damages/defects prior to lifting

  Yes

  No

  N/A

• Inserts tines safely & stops when load rests against back rest

  Yes

  No

  N/A

• Adjusts pallet to safe travel height before moving.

  Yes

  No

  N/A

• Stacks cartons safely and correctly on pallet (actively reduces fall hazard)

  Yes

  No

  N/A

TRAVEL

• Constantly looks for hazards in direction of forward travel.

  Yes

  No

  N/A

• Travels at safe speed without abrupt turning or stopping

  Yes

  No

  N/A

PLACING LOAD

• Completes shoulder check prior to withdrawing, displaying awareness of potential hazards

  Yes

  No

  N/A

• Correct body positioning with walk behind to avoid being hit or hitting something else

  Yes

  No

  N/A

• Stores MHE in safe location when not in use (or can communicate to do so)

  Yes

  No

  N/A

Assessors Recommendation

• Operator assessed as competent

  Yes

  No

  N/A

• Operator requires reassessment

  Yes

  No

  N/A

• Assessors name

• Assessors signature

  Sign

• Operator name

• Operators signature

  Sign