On Site Vehicle Safety Observation Form

• Site conducted

  Select

• On Site Vehicle Safety Observation Form

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

Plant Vehicle

• Type of plant equipment?

  Select Counterbalance forklift 360 Grab Tractor MEWP (with boom) MEWP (scissor lift) TOW truck

  • Counterbalance forklift
  • 360 Grab
  • Tractor
  • MEWP (with boom)
  • MEWP (scissor lift)
  • TOW truck

Operator Details

• If an operator has no proof of training held on record, they must not operate a forklift truck until proof of training competency has been proven

• Does the operator hold a valid training certificate that has been passed or refreshed within the last three years?

  Pass

  Fail

  N/A

• Date of test or refresher course?

  Date

Daily Safety Inspection

• The operator completes the safety pre-shift safety inspection correctly?

  Pass

  Fail

  N/A

• The operator understands the correct fault reporting procedures?

  Pass

  Fail

  N/A

Operator Safety & Observation

• The operator mounts / dismounts correctly?

  Pass

  Fail

  N/A

• Uses the seatbelt correctly?

  Pass

  Fail

  N/A

• Keeps body parts within the confines of the vehicle?

  Pass

  Fail

  N/A

• Operator looks in the direction of travel?

  Pass

  Fail

  N/A

• Correct use of the horn when appropriate?

  Pass

  Fail

  N/A

• Follows the correct procedures for an "unattended" vehicle?

  Pass

  Fail

  N/A

Steering & Operating Controls

• Starts and stops smoothly?

  Pass

  Fail

  N/A

• Releases the parking brake prior to moving off?

  Pass

  Fail

  N/A

• Operates the hydraulic controls as per training received?

  Pass

  Fail

  N/A

• Operates and understands all other controls as per training received?

  Pass

  Fail

  N/A

Competency In Load Capacity

• Operator matches load with the vehicles capacity?

  Pass

  Fail

  N/A

• Operator checks the load for stability?

  Pass

  Fail

  N/A

Manoeuvring & Transportation

• Forks at the correct height when traveling?

  Pass

  Fail

  N/A

• Operates at a speed consistent with the type of load and working conditions?

  Pass

  Fail

  N/A

• Operator performs safe manoeuvring with the vehicle and load i.e pedestrians at safe distance, load is stable when moving?

  Pass

  Fail

  N/A

Stacking & de-stacking

• Fork arms central under the load?

  Pass

  Fail

  N/A

• Fork arms not rubbing (entry / withdrawal)?

  Pass

  Fail

  N/A

• Forks / load level?

  Pass

  Fail

  N/A

• Load correctly stacked?

  Pass

  Fail

  N/A

Parking

• The operator correctly applies the park brake?

  Pass

  Fail

  N/A

• The operator sets the direction lever to the neutral position?

  Pass

  Fail

  N/A

• The operator correctly applies forward tilt?

  Pass

  Fail

  N/A

• The operator correctly lowers the fork arms/ 360 grab boom/ MEWP?

  Pass

  Fail

  N/A

• The manoeuvring wheels are in the straight position?

  Pass

  Fail

  N/A

• The operator switches off and removes the key?

  Pass

  Fail

  N/A

Assessment Recommendations & Evaluations

• Assessors evaluation of operator safety?

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Comments

Signatures

• Date and time of assessment

  Date

• Operator signature

  Sign

• Assessor signature

  Sign