Electric pallet jack competency

• Audit title

• Conducted on

  Date

• Prepared by

• Location
  Address

Safety inspections

• Completes pre-operational safety inspection & checklist

  Yes

  No

  N/A

• Knows steps in reporting faulty/unsafe equipment

  Yes

  No

  N/A

Load - pick up

• Adheres to the safety rules of the site (uses horn at intersections/near other MHE etc)

  Yes

  No

  N/A

• Checks for hazards (pedestrians/ other MHE) prior to moving off via shoulder checks

  Yes

  No

  N/A

• Checks pallet and load for damages/defects prior to lifting

  Yes

  No

  N/A

• Inserts tines safely and stops when load touches back rest of MHE

  Yes

  No

  N/A

• Adjusts pallet to safe travel height before moving

  Yes

  No

  N/A

• Stacks cartons safely and correctly on pallet

  Yes

  No

  N/A

Travel

• Complies with forklift exclusion zone (3m+height of tines)

  Yes

  No

  N/A

• Constantly look for hazards in direction of travel (forward and reverse)

  Yes

  No

  N/A

• Travels at safe speed without abrupt turning or stopping

  Yes

  No

  N/A

Placing load

• Completes should check prior to withdrawing, displaying awareness of potential hazards <br>

  Yes

  No

  N/A

• Correct body positioning using walk behind to avoid being hit or hitting something else

  Yes

  No

  N/A

• Stores MHE in safe location when not in use (or can communicate to do so)<br>

  Yes

  No

  N/A

Accessors recommendation

• Operator assessed as competent

  Off

  On

• Operator requires reassessment

  Off

  On

• Assessors signature

  Sign

• Operator signature

  Sign