2. List the positive and improvement opportunities found.
3. Develop corrective action and recognition.
4. Track follow-up action until completion (recognition or corrective action)
5. Retain scans for 6 months.
Is the location clean and orderly?
Are there any tripping hazards that need to be fixed?
Is the employee using proper material handling techniques?
Is proper material handling being utilized?
Are pallets stacked too high to reach?
Have you done your pre-shift stretching today?
Are 3 points of contact being used when entering and exiting the truck?
Are proper lifting techniques being used?
Are proper driver methods being used?
Are truck wheels chocked
Are pre-shift inspections being completed?
Is the employee wearing the seatbelt? Give instant feedback (positive or negative)
Is the forklift operator driving in a safe manner?
Is the forklift driver using a horn?
Is the proper dock loading/unloading procedure being used? Check key control, doors closed when not loading, etc.
Do you feel you have received sufficient safety training for your job?
How would you evacuate in an emergency?
Do you have any suggestions to make this branch a safer place to work?
What are you personally working on to improve your safety and that of your co-workers?
Number of deficiencies noted:
Number of positive actions:
Number of employee interactions
Note what you observed:
Provide information on the instant feedback given to the employee (positive and improvement requirements):
What will the employee be working on to improve?