Operation of Power Equipment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Completion of Pre-shift Power Equipment Checklist

• Has Pre-Shift checklist been competed on a random sampling of operators/equipment? Sample size = 10<br>

  Yes

  No

  N/A

Safe Operating Behaviours

• Are equipment operators using two hands on pallet jacks when in motion? (one hand on steering arm; one hand on grab bar) Sample Size = 10 employees

  Safe

  At Risk

• Select date

  Date

• Is equipment horn being used at intersections, blind spots or around pedestrians? Sample size = 5 minute observation

  Safe

  At Risk

• Select date

  Date

• Are employees waiting until equipment is fully stopped before dismounting? Remember it is ok to walk and have equipment on coast,but not to ride and coast. Sample size 10 employees

  Safe

  At Risk

• Are employees keeping their body parts (hands,feet head) within the confines of the equipment? Sample size = 10

  Safe

  At Risk

• Are employees using electronic equipment while operating equipment?

  Safe

  At Risk

• Select date

  Date

• Are employees focusing on their travel path?

  Safe

  At Risk

• Select date

  Date