• Let the operator know you will be observing him/her performing work for approximately 5 minutes and will then provide feedback.

  • Please include details on all At Risk findings in spaces below

Daily Inspection

  • Did the operator inspect the following items during his/her daily inspection?

  • Obvious damage

  • Cracked frame welds

  • Model tag readable

  • Tires (proper inflation and cut free)

  • Leaks

  • Charging cord unplugged

  • Wire insulation undamaged

  • Safety strobe light

  • Battery Connections

  • Steering

  • Brakes

  • Horn (switch must be turned on)

  • Battery discharge indicator

  • If leaving vehicle, turn off switch

  • 2. Is the operator wearing all required PPE correctly and mule card is completed for current shift?

Behavior Based Observations

  • 3. Is the operator Focused on task?

  • 4. Backing up less than 5 steps before moving forward?

  • 6. Looking in direction if travel when using mule?

  • 8. Is the operator using the appropriate speed for the task and location and maintaining a safe distance from others?

  • 9. Is the operator yielding to and making eye contact with pedestrians and other operators?

  • 10. Is the operator using horn while going through doors, around corners,behind people, etc.?

  • 11. No use of any electronic devices while operating mule?

  • 12. Is the operator reporting and removing congestion and debris in path?

  • 13. Is the operator maintaining a safe clearance from obstacles?

  • 14. Is the operator using two hands to operate the mule when positioning load?

  • Operator Signature

  • Evaluator Signature

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