HS055- Forklift checklist

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Pre start checklist is to be completed every day prior to using the equipment. Operator is to answer “Y, Pass, Safe" for checked and working and “N, Fail, at Risk” for faulty or damaged, NA for not applicable. Supervisor is to review the checklist and sign off at the end of each week

• All defects to be reported immediately to Manager/Supervisor. Faulty machine can’t be used unless permission given from Manager/Supervisor. Any visual damage of equipment must have pictures taken and attached to this report.

  

• Do you agree to wear seatbelts at all times while driving any of Fork trucks?

  Yes

  No

  N/A

• Forklift Type

• Forklift Number

• Date (Week Commencing Mon)

  Date

• BATTERY LEVELS

  Good

  Fair

  Poor

  N/A

• FAN/OTHER BELTS

  Pass

  Fail

  N/A

• OBVIOUS LEAKS PRESENT

  Pass

  Fail

  N/A

• HYDRAULIC FLUID LEVELS

  Pass

  Fail

  N/A

• CHAINS & FIXING BOLTS

  Safe

  At Risk

  N/A

• FORKS

  Safe

  At Risk

  N/A

• BACKREST

  Good

  Fair

  Poor

  N/A

• TYRES/WHEELS/NUTS

  Good

  Fair

  Poor

  N/A

• SEAT & SEAT BELT

  Pass

  Fail

  N/A

• STEERING

  Pass

  Fail

  N/A

• SERVICE BRAKES

  Pass

  Fail

  N/A

• PARKING BRAKE

  Pass

  Fail

  N/A

• OPERATING CONTROLS

  Pass

  Fail

  N/A

• OPERATING SYSTEM

  Pass

  Fail

  N/A

• WARNING LIGHTS

  Pass

  Fail

  N/A

• GAUGES

  Pass

  Fail

  N/A

• HORN

  Pass

  Fail

  N/A

• ALARMS ON REVERSE

  Pass

  Fail

  N/A

• LIGHTS/BEACON

  Pass

  Fail

  N/A

• SAFETY GUARDS

  Pass

  Fail

  N/A

• BODYWORK

  Pass

  Fail

  N/A

• BATTERY CARE & MAINTENANCE

  Good

  Fair

  Poor

  N/A

• OTHER

• Initials/ Sign of operator:

ACTION TAKEN:

• SUPERVISOR/MANAGER NAME:

• DATE:

  Date

• Signature:

  Sign