Title Page

  • Audit Title


  • Conducted on

  • Select date


  • Completes pre-operational safety inspection & checklist

  • Knows steps in reporting faulty/unsafe equipment


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

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

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

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

  • Adjusts pallet to safe travel height before moving.

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


  • Constantly looks for hazards in direction of forward travel.

  • Travels at safe speed without abrupt turning or stopping


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

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

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

Assessors Recommendation

  • Operator assessed as competent

  • Operator requires reassessment

  • Assessors name

  • Assessors signature

  • Operator name

  • Operators signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.