Title Page

  • Employee Name

  • Employee Number

  • Pallet Jack number

  • Conducted on

  • Prepared by

Equipment Operation

  • Properly Inspects Equipment - prior to use (verified through documentation).

  • Keeps both Feet on the Platform - both Hands on the Controls - when traveling on equipment.

  • Maintains Situational Awareness - always looks in direction of travel.

  • Fully Stops Equipment - before mounting/ dismounting.

  • Sounds Horn - and slows down when approaching doors, curtains, and blind corners.

  • Makes Eye Contact - sounds horn prior to passing equipment or foot traffic.

  • Powers Off Equipment - fully lowers forks when leaving the equipment unattended or more than 25ft. Away.

  • Other

Comments/Additional Needs

Signature

  • Employee

  • Supervisor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.