Title Page

  • Employee Number?

  • Conducted on

  • Observation performed by?

  • Observation Number

General Information

  • Location?

  • Reason for Observation?

PIT Basics

  • Does Operator have valid certification card?

  • Is Operator certified to operate PIT?

  • Is PIT pre-trip inspection form completed correctly?

PIT Operations

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

  • Does Operator sound horn when nearing intersections or people?

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

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

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

  • Does Operator stop PIT before dismounting?

  • Does Operator stop PIT in position to allow others to pass safely?

Order Selection

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

  • Does Selector build a safe and secure pallet?

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

  • Does the Selector pick cases from top of pallet first?

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

  • Does Selector walk forward while wrapping pallets?

Overall Safety

  • Overall Safety Behaviors of today.

  • Signature of Employee observed.

  • Signature of Observer.

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.