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 other selectors, lumpers, porters, & 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 (20' for "working Hi-Lo")
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Employee keeps all body parts within the frame of the equipment.
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Employee looks before dismounting.
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Employee conducts pre-shift inspection.
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Employee looks in the direction of travel before moving (after staging pallet or picking up a pallet).
Personal Safety
Personal Safety
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Employee uses legs for lifting.
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Employee keeps cases close to the body when lifting.
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Employee does not bend and twist while carrying cases.
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Employee does not ever step on empty pallets or forks.
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Employee uses selector stick when necessary.
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Employer backs completely out of pallet before wrapping (never stepping on pallets or forks).
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Employee moves and handles 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:
