Lindamood Operator Safety Observation Form

• Document No.

• Operator Safety Observation

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date

  Date

• Operator name

• Observer name

• Type of equipment

Visual Checks

• Were the structure of the machine and any attached implements properly inspected?

  Yes

  No

  N/A

• Were the wheels and tires or tracks and undercarriage properly inspected?

  Yes

  No

  N/A

• Did the operator assure that the fluid levels were adequate and check for any leaks while inspecting the engine compartment?

  Yes

  No

  N/A

• Were the guards and covers inspected to assure that they were in serviceable condition?

  Yes

  No

  N/A

• Did the operator assure that all required decals were in place and legible?

  Yes

  No

  N/A

• Was the operator able to locate the capacity plate and explain the data it contained?

  Yes

  No

  N/A

• Did the operator assure that the operators manual was in its compartment, and were they able to demonstrate that they were familiar with its contents?

  Yes

  No

  N/A

• Did the operator assure that the machine was equipped with a seat belt?

  Yes

  No

  N/A

Operator checks

• Did the operator check the instrument readings, and were they able to understand them?

• Were the lights and horn tested to assure that they were working properly?

• Did the operator assure that the controls were operating normally?

• Were the directional and speed controls checked for proper operation?

• Wert the steering and brake systems tested?

Basic operating procedures

• Was the machine operated in a smooth and competent manner?

• Were loads kept at a safe height while being transported?

• Was the machine operated at a safe speed for the conditions at hand?

• Did the operator keep a clear view of the path that they were traveling?

• Did the operator maintain an awareness of all obstacles around them and maintain the appropriate clearances? Power lines, ground crew, other equipment, etc.

• Did the operator maintain control of the machine at all times?

• Was the machine operated only in the designated areas?

• Did the operator check the clearances behind the machine before backing?

• Were all turns started in the proper position?

• Did they check the load before lifting?

• Did they approach and lift the load properly?

• Were they able to load properly?

• Was the machine parked correctly and safely?

General safety

• Was the horn used as needed?

• Did the operator yield to pedestrians?

• Did the operator keep all body parts inside the cab while operating?

• Did the operator use the seat belt and adjust the fit correctly?

• Did the operator demonstrate competence in refueling/charging the machine?

• Did the operator properly mount and dismount the machine?

Work or other equipment specific observations

• Additional observations

Comments

• Comments

• Operator signature

  Sign

• Observer signature

  Sign