Core-Mark CSA Sanitation

• 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 nearing intersections or 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 stop PIT in position to allow others to pass safely?

  Yes

  No

Cleaning

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

  All of the time

  Most of the time

  Some of the time

  Never

• Does Sanitor use appropriate PPE?

  Yes

  No

• Does Sanitor immediately quarantine spill/hazard area?

  Yes

  No

• Does Sanitor maintain appropriate supplies to address spills/damage?

  Yes

  No

• Does Sanitor complete required daily/weekly paperwork?

  All of the time

  Most of the time

  Some of the time

  Never

Overall Safety

• Overall Safety Behaviors observed today.

  Safe

  At Risk

• Signature of Employee observed.

  Sign

• Signature of Observer.

  Sign