Title Page
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Employee Name
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Employee Number
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Pallet Jack number
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Conducted on
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Prepared by
Equipment Operation
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Properly Inspects Equipment - prior to use (verified through documentation).
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Keeps both Feet on the Platform - both Hands on the Controls - when traveling on equipment.
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Maintains Situational Awareness - always looks in direction of travel.
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Fully Stops Equipment - before mounting/ dismounting.
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Sounds Horn - and slows down when approaching doors, curtains, and blind corners.
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Makes Eye Contact - sounds horn prior to passing equipment or foot traffic.
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Powers Off Equipment - fully lowers forks when leaving the equipment unattended or more than 25ft. Away.
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Other
Comments/Additional Needs
Signature
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Employee
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Supervisor