Core-Mark CSA Pallet Loading

• 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

PIT Basics

• Does Operator have valid certification card?

  Yes

  No

• Is Operator certified to operate PIT?

  Yes

  No

• Is PIT pre-trip inspection form completed correctly?

  Yes

  No

PIT Operations

• Does Operator look in the direction of travel while operating PIT?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Operator sound horn when exiting trailers, doors or near people?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Operator leave safe clearance when passing others and pallets/product?

  All of the time

  Most of the time

  Some of the time

  Never

• Are both of Operator's feet within limits of foot platform?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Operator use four points of contact when operating PIT?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Operator stop PIT before dismounting?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Operator check trailer surface prior to entering?

  Yes

  No

Loading

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

  All of the time

  Most of the time

  Some of the time

  Never

• Is trailer clear of debris prior to loading?

  Yes

  No

• Are all straps neatly placed to side of trailer prior to loading?

  All of the time

  Most of the time

  Some of the time

  Never

• Does Loader pull forks completely out of pallets prior to wrapping pallets?

  Yes

  No

• Does Selector walk forward while wrapping pallets?

  All of the time

  Most of the time

  Some of the time

  Never

• Is dock and trailers kept in safe working order while performing loading functions?

  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