Crown Equipment Training Sign Off

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Equipment Type

• Pallet jack

  Yes

  No

  N/A

• WAVE

  Yes

  No

  N/A

• Walkie Stacker

  Yes

  No

  N/A

Safety Procedures

• Safe work procedure has been followed and signed

  Yes

  No

  N/A

Skill Assessment

• Turn machine on/off

  Yes

  No

  N/A

• Safety equipment worn i.e. steel cap boots, high vis clothing

  Yes

  No

  N/A

• Safety check list completed

  Yes

  No

  N/A

• Maneuver machine:<br>- forwards, reverse, turning<br>- raising/lowering forks or self (wave)

  Yes

  No

  N/A

• Environment checked and safe i.e. clear of obstacles, people etc

  Yes

  No

  N/A

• Moving loads:<br>- raising/lowering pallets<br>- forks/tray adjusted to load size<br>- load is secure and evenly distributed

  Yes

  No

  N/A

• Emergency stop button used, and horn when appropriate

  Yes

  No

  N/A

• Machine when not in use is parked safely and keys removed

  Yes

  No

  N/A

Test

• Carrying persons is acceptable on the machines?<br>

  Yes

  No

  N/A

• How often and when is the safety checklist completed

  Once at the end of the day

  twice a day whenever you can

  at the beginning of the day before using the machine

• Is it ok to still use the machine once a major defect has been found if its absolutely necessary?

  Yes

  No

  N/A

Sign off

• Trainee

  Sign

• Assessor

  Sign