Title Page
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Conducted on
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Prepared by
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Location
Prior to beginning work
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Was a documented inspection completed on the forklift or skid steer?
Housekeeping
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Are walkways and aisle-ways kept clear of debris and tripping hazards?
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Do walkways have adequate lighting when working at night or before daylight?
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Is trash, wood, metal, plastic, or other items laying around the area?
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Are areas accessed by heavy equipment/trucks/forklifts cleaned and graded so no tripping hazards are present?
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Are roadways kept smooth and accessible for delivery drivers?
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Are trash receptacles readily available in work and break areas?
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Are trash dumpsters emptied on a regular basis?
Material Storage
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Are materials stacked in a safe manner to prevent tipping or falling over?
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Are materials secured to a pallet for safety and ease of loading and unloading?
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Are loose materials stored separately from other materials to reduce the risk of a tripping hazard?
Report Information
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Weather conditions
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Signature
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Date and Time of Assessment