Title Page
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Conducted on
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Prepared by
1.0 Morning Yard Check
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1.1 Did the driver check his hours before clocking in?
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1.2 Did the driver log into the ELD before departure?
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1.3 Did the driver conduct a proper Pre-Trip inspection before departure?<br> -Interior cab including defroster, wipers, gauges, horns, lights, emergency equipment, air pressure check, past trip DVIR<br> -Engine Compartment including belts, hoses, wires, air dryer, shock and springs, brake pads, drums, cans, fluid levels<br> -Circle Check including tires, rims, fuel tanks & straps, cap chains, air cans, shocks, under carriage, lights, bumpers, axles, frame and lifts/ramps<br> -Load
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1.4 Did the driver gather all essential equipment before departure?
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1.5 While in the yard did the driver obey 10 mph speed limits and stop at all stop signs?
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1.6 Was the driver secured with a seatbelt before moving?
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1.7 Did the driver use headlights and emergency flashers while in the yard?
2.0 Smith System Driving
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2.1 Did the driver review his paperwork and address anticipated issues with dispatch?
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2.2 Does the driver check his surroundings before departure by using S.M.O.G.?<br> -Signal, Mirrors, Over the Shoulder, Go
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2.3 Does the driver tap their horn before leaving a parked location or backing?
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2.4 Is Key 1, Aim High In Steering, utilized?<br> -Scan the road in front of the vehicle by 15 seconds<br> -Adjust space by reducing speed or changing lanes to minimize risk
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2.5 Is Key 2, Get The Big Picture, utilized?<br> -Scans at least one mirror every 5-8 seconds<br> -Scans intersections prior to entry<br> -Stops far enough behind stop lines and comes to complete stop
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2.6 Is Key 3, Keep Your Eyes Moving, utilized?<br> -Does not stare at objects for more than 2 seconds<br> -Activates peripheral vision, fights fatigue and increases awareness.
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2.7 Is Key 4, Leave Yourself An Out, utilized?<br> -Maintains 4 second following distance<br> -Maintains proper space around vehicle, does not get trapped into a space
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2.8 Is Key 5, Make Sure They See You, utilized?<br> -Communicates with others with lights, horns and hand to make themselves more visible<br> -Uses turn signals with proper timing<br> -Avoids pedestrian heavy areas in parking lots<br> -Turns on flashers and lights in parking lots
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2.9 Is the driver using Smith System when backing?<br> -Pre-plans parking/dock choices thinking about departure upon arrival<br> -Scans the entire area for the safest parking locations and travel path<br> -Chooses parking area to reduce conflicts<br> -Backs slowly, less than 2 mph, and uses horn while backing<br> -Communicates with others to make intentions known
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2.10 Did the driver refrain from using electronic devices while driving?
3.0 Hours of Service
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3.1 Does the driver continually check his available hours and communicate issues with dispatch?
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3.2 Did the driver take their required 30 minute brake at the proper time (not too early, not too late)?
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3.3 We’re there any HOS violations throughout the day?<br> -10 hours off<br> -30 min brake after 8 hours of duty time<br> -Drives no more than 11 hours<br> -Does not drive after having been on duty for 14 hours unless a Big Day (16 hour alibi) is available<br> -Does not remain on the clock after 16 hours if the alibi is used<br> -Not on duty for more than 70 hours in any 8 day period
4.0 Safety In Motion
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4.1 Did the driver stretch prior to working the load?
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4.2 Maintains proper elbow positions when lifting.<br> -Green Zone (elbows touching the sides on their body)<br> -Yellow Zone (elbows within 6 inches on the sides of their body)<br> -Red Zone (elbows past 6 inches from the sides of the body, not to be in this position)<br> -Uses 2 hands when at all possible
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4.3 Flexes knees when lifting.<br> -Can be used also to reduce risk of injury when reaching out into the red zone
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4.4 Aligns spinal incurves.<br> -Head up, chest out, butt out
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4.5 Uses Mid-Range wrist motion.<br> -Does not hyper flex the wrist up, down, or side to side<br> -Pushes with the pinky side of the hand<br> -Relaxes thumb and index finger when gripping objects<br> -Changes objects position to utilized mid-range wrist motion
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4.6 Does not lift objects that are too heavy or that are out of the Power Zone (waist high).<br> -Objects lifted over the head should be 10 lbs or less<br> -Objects being lifted from the ground should be less than 25 lbs and proper position used<br> -NO OBJECTS more than 55 lbs should be lifted without help
5.0 End of Day
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5.1 Did the driver perform proper post-trip inspection?<br> -Physical inspection (See morning yard check)
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5.2 Did the driver fill out the DVIR form correctly?<br> -Was the proper forms taken to the proper places (garage, office, truck)?
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5.3 Did the driver log out of the ELD properly?
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5.4 Was equipment replaced to the proper locations?
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5.5 Was final day paperwork filed out correctly and turned in?
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5.6 Did the driver review their HOS before leaving?<br> -How many hours were worked that day<br> -How many hours are available for the next work day<br> -When can they return to duty (10 off or 34 hour reset necessary)
6.0 PPE
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6.1 Did the driver use a HiViz vest while in the yard or busy parking lots?
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6.2 Did the driver have the proper uniform and was it clean and in good shape?
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6.3 Was the driver using the proper hook and was it sized correctly?
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6.4 Was the driver using proper approved footwear?
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6.5 Was the hand truck in good condition?
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6.6 If required, was the driver using Winter Walkers?
7.0 Did you or the driver have any other safety concerns?
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7.0 Type information here or add pictures
