Please Observe & Respond to the following Questions:

  • Driver wearing all required PPE?

  • Driver's wheels chocked?

  • Driver grounded truck prior to transfer?

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

  • Driver has placed the fire extinguisher near transfer area?

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

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

  • Driver is alert and fit for duty?

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

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

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

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

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

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

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

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

  • Please comment if any questions above are answered NO:

  • Positive feedback and additional comments:

  • Prepared by:

JSA completed

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