Driver Safety Blitz

• Driver

• Conducted on

  Date

• Prepared by

• Location
  Address

• Truck Number

  Media

• Trailer Number

  Media

Parking Safety

• Does the driver use three (3) points of contact when entering/exiting the truck or trailer?

  Yes

  No

  N/A

• Did the driver use the G.O.A.L. method prior to backing?

  Yes

  No

  N/A

• Does the driver have safety cones on the truck?

  Yes

  No

  N/A

• Are safety cones in place?

  Yes

  No

  N/A

• Does the driver park with safe a clearance of curbs or sidewalks?

  Yes

  No

  N/A

• Did the driver leave the vehicle in safe condition when out of the cab? (i.e. parking brakes, engine turned off, emergency lights/flashers on?)

  Yes

  No

  N/A

• Does the driver secure all open swinging doors?

  Yes

  No

  N/A

PPE

• Is the driver wearing a Sysco shirt?

  Yes

  No

  N/A

• Is the driver wearing safety boots?

  Yes

  No

  N/A

• Does the driver have gloves for handling packages?

  Yes

  No

  N/A

Roll Off Operation

• Is there a pallet jack in the trailer?

  Yes

  No

  N/A

• Is there a dolly with a hand brake?

  Yes

  No

  N/A

• Does the driver use the "stack & scan" technique for deliveries?

  Yes

  No

  N/A

• Does the driver back up to dock slowly while checking mirrors?

  Yes

  No

  N/A

• Is the trailer ramp in good condition and properly secured?

  Yes

  No

  N/A

Driver Survey

• Is the driver satisfied with his/her current role at Sysco?

  Yes

  No

  N/A

• Does the driver feel that he/she is being recognized for your contributions at work?

  Yes

  No

  N/A

• Does the driver have a good working relationship with the current customer?

  Yes

  No

  N/A

• Does the driver that his/her co-workers and supervisors are supportive?

  Yes

  No

  N/A

• What the overall attitude of the driver?

  Good

  Fair

  Poor

  N/A

Delivery Partner Feedback

• Are there any additional safety concerns that were addressed by management?

  Yes

  No

  N/A

• Does the driver have any additional safety concerns?

Signature

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