Prairie Driver Observation Checklist - version 7/2016

• Driver Being Observed:

• Tractor & Trailer Number

• Conducted on

  Date
• Location
  Address

Please Observe & Respond to the following Questions:

• Driver wearing all required PPE?

  Yes

  No

  N/A

• Driver's wheels chocked?

  Yes

  No

  N/A

• Driver grounded truck prior to transfer?

  Yes

  No

  N/A

• Driver placed cones in front of truck and back of tanker?

  Yes

  No

  N/A

• Driver has placed the fire extinguisher near transfer area?

  Yes

  No

  N/A

• Driver is NOT using any electronic devices during the product transfer?

  Yes

  No

  N/A

• Driver following procedures for oil buying process?

  Yes

  No

  N/A

• Driver is outside the cab, ready to disengage the pump and stop flow during product transfer?

  Yes

  No

  N/A

• Driver has completed JSA for current site?

  Yes

  No

  N/A

• Driver is alert and fit for duty?

  Yes

  No

  N/A

• Driver has verbally stated at least 4 of the Life-Saving rules?

  Yes

  No

  N/A

• Driver has log book current to last change of duty status?

  Yes

  No

  N/A

• Driver is aware of Stop Work Authority

  Yes

  No

  N/A

• Driver is aware of the Maximum speed limit of 65 MPH?

  Yes

  No

  N/A

• Driver is aware and able to show evidence of the Journey Management planning process?

  Yes

  No

  N/A

• Driver has Safety Data Sheets (SDS) and Emergency Response Guidebook in his possession?

  Yes

  No

  N/A

• Driver is aware of First Aid and product handling requirements contained in the SDS?

  Yes

  No

  N/A

• Driver is aware of "Destination Zero" Driver Pledge, You Decide" and Learning From Incidents (LFI) communications?

  Yes

  No

  N/A

• Driver is aware of In-Vehicle Monitoring System and receives performance feedback from supervisor?

  Yes

  No

  N/A

• Driver receives Safety, Operations, Motivational or Fit for Purpose messages communicated through IVMS?

  Yes

  No

  N/A

• Please comment if any questions above are answered NO:

• Positive feedback and additional comments:

• Prepared by:

  Sign