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
Equipment Operation
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Employee stops at all intersections, doors, & required areas.
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Employee operates at a safe speed.
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Employee sounds horn near pedestrians, blind spots, and other operators.
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Employee drives in correct direction (Doors, Aisles) and does not walk through blue quick opening doors.
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Employee works safely around selectors, lumpers, porters, & other Hi-Lo operators.
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Employee does not dismount vehicle until it is completely stopped.
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Employee keeps proper distance between other vehicles.
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Employee properly puts pallets in correct position/location.
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Employee keeps all body parts within the frame of equipment.
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Employee looks in the direction of travel before moving equipment.
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Employee looks before dismounting.
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Employee conducts pre-shift inspection.
Personal Safety
Personal Safety
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Employee lifts properly.
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Employee stays 20' away from a selector before elevating or dropping a load.
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Employee cuts and removes plastic from skid prior to placing in pick slot.
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Employee places skid in slot safely, squarely, and without damage.
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Employee moves, handles, and sorts pallets properly.
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:
