Core-Mark CSA Each Selection

• Employee Number?

• Conducted on

  Date

• Observation performed by?

• Observation Number

General Information

• Location?

  Bakersfield

  Hayward

  Sacramento

  Corona

  Los Angeles

• Reason for Observation?

  New Hire

  Random

  Post Incident/Accident

Safety/Sanitation

• Does Selector verify tote is clean for use?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Selector verify the tote is safe? No major cracks, loose wires or sharp edges?

  All of the time

  Most of the time

  Some of the time

  Never

• Can the Selector identify e-stops and evacuation routes?

  Yes

  No

Order Selection

• Does Selector use two hands to carry tote?

  Yes

  No

• Does Selector use proper lifting techniques/green zone lifting?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Selector safely remove totes from inbound tote pallet?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Selector use case hook to reach cases beyond safe reach?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Selector close tote completely prior to pushing onto take-away line?

  Yes

  No

• Does Selector "clean as they pick" to ensure a safe working area?

  All of the time

  Most of the time

  Some of the time

  Never

Overall Safety

• Overall Safety Behaviors of today.

  Safe

  At Risk

• Signature of Employee observed.

  Sign

• Signature of Observer.

  Sign