Information
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Employee name
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Client / Site
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Conducted on
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Prepared by
Equipment Operation and Personal Safety
Employee Health and Safety Observation
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Checker visibly wears orange safety vest.
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Checkers works safely around "lumpers" and other employees.
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Checker works safely around and in-between pallets (never stepping on pallets or forks).
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Checker is alert to hazards while walking and working in the dock.
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Checker safely operates pallet jack or other powered industrial equipment.
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Checker ensures trailer is chocked, and operating at proper temperature.
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Checker ensures product is at proper temperature.
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Housekeeping, area is clean and free of debris.
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Checker ensures that no unsafe pallets of product are received.
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Checker rejects pallets that are not properly stacked and wrapped, and has the lumper service correct all problems before pallet is received.
Actions
Actions and comments.
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Is further corrective action or training necessary?
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Additional comments and/or observations:
Signatures
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Employee signature:
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Observer Signature:
