HS055- Forklift checklist v:2

• 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

  Select Counterbalance Reach truck Aisle Master Pallet truck no 1 Pallet truck no 2 Pallet truck no 3 Line Pallet truck

  • Counterbalance
  • Reach truck
  • Aisle Master
  • Pallet truck no 1
  • Pallet truck no 2
  • Pallet truck no 3
  • Line Pallet truck

• Forklift Number

  Select Reach truck serial: RTB30A10298 Counterbalance serial: 3902220091 Aisle master serial: 64161 Pallet truck serial: 1801230039 Pallet truck serial: 1801230048 Pallet truck serial: 1801230049 Linde Pallet truck serial: W4X13 1C04327

  • Reach truck serial: RTB30A10298
  • Counterbalance serial: 3902220091
  • Aisle master serial: 64161
  • Pallet truck serial: 1801230039
  • Pallet truck serial: 1801230048
  • Pallet truck serial: 1801230049
  • Linde Pallet truck serial: W4X13 1C04327

• 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

• HYGIENE INSPECTION POINTS: Cabin clean and free from debris?<br>Windows clean and free from debris?<br>Steering wheel clean?<br>Seat clean and free from debris?<br>Controls clean and free from debris?

  Compliant

  Non-Compliant

  N/A

• Initials/ Sign of operator:

• undefined

ACTION TAKEN:

• SUPERVISOR/MANAGER NAME:

• DATE:

  Date

• Signature:

  Sign