Equipment Condition

Backing Alarm



Parking Brake


Overhead Unobstructed


Operator Qualification Training ( Ask employee when the last time was they put through recertification )

Training Properly Documented (Contact Bernie Janitia if unsure)

Knows Load Capacity

Knows Maximum Overhead Reach

Operating Skills

Travel Speed-Forward

Travel Speed-Reverse

Use of Controls

Stopping/Use of Brakes

Load Carry Position

Use of Parking Brakes

Leaves Mast Vertical and Forks Down

Personal Safety

Hard Hat as Required

6" High Work Boots

ANSI Class 2 Vest and Clothing

Safety Glasses

Mount/Dismount (3 pt contact)

Uses Seat Belts

Any Other Unsafe Acts?


Was Equip LO/TO with Pad Lock & Tags ( if not in use ask employee where they are located)

Was all Keys Removed ( If LO/TO is not in use at time of observation explain to employee why keys should be removed)

Employee understand LO/TO Principles

Employee know where to find LO/TO program for Reference

Employee Blocks or Chalks Wheels ( Explain to employee that they should be available in case of break down or for emergency use )

Operator Comments

Operator Signature

Observer Comments

Observer Signature
Add any Pictures Relevant to Observation

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.