Information
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Client / Site
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Location
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Conducted on
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Prepared by
Truck Information
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Truck Type
- Counterbalance
- Reach
- Pedestrian Pallet
- Pedestrian Mast
- Pedestrian Reach
- Other
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Other type
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Make
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Model
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Serial Number
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Capacity
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Motive power
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Attachments
- Forks
- Bale Clamp
- Spike
- Work Platform
- Barrel Clamp Attachment
- Tip Skip
Operator Safety Information
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Has the operator been trained or refreshed within the last three years?
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Is there a copy of the operators certificate in their training file?
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Has the operator signed an authorisation to operate form, renewable annually?
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Is the operator aware of the correct fault reporting procedures?
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Has the operator certification and authorization to operate records been checked?
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Date of training or refresher course
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Date of company written authorisation
Visual checks
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Carriage pate Is the safety data information plate attached and legible
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Load handling device (forks, clamp, etc)
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Backrest extension
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Mast
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Mast rollers & slides
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Lift chains
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Chain pulleys
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Hydraulic rams
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Hydraulic cables
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Wheels
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Tyres
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All round external condition
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Counterweight
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Operators position
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Operators seat & seat restraint
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LPG cylinder (LPG powered truck)
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Lights
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Has the key been removed when the lift truck is unattended
Operational Safety Checks
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Starting procedure (engine truck)
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Starting procedure (electric truck)
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Starting procedure (LPG truck)
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Audible warning system
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All hydraulic systems
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Driving operation (no play in the steering)
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Foot brake function
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Park brake function
Evaluation
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Overall evaluation
Completion
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Full Name and Signature of Operator
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Full Name and Signature of Safety Officer