Ride-along and Observation Form Checklist

• Driver Name

• Job Title

  SSR

  VSSR

  OSSR

  Other

• Description

• Years of Service

• Primary Job or Cross-Trained Position?

  Primary

  Cross-Trained

Types of services performed during Ride-Along (check all that apply)

• Solvent Parts Washers

• Aqueous Parts Washers

• Paint Gun Cleaner

• Dry Cleaning Service

• Containerized Waste Service

• Oil Services

• Vacuum Services

• Allied Product Sales

• Sales Calls/Sampling

• Oil Product Delivery

• AC, RC, DC Delivery/Pickup

• Bulk Oil Filters

• Rail Transfer

Select Satisfactory, Unsatisfactory, or Not Applicable for each question.

• Wears Eye Protection

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Wears Hand Protection

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Wears Respiratory Protection

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Wears Hearing Protection

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Wears Hard Hat

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Are proper tools being used for tasks (drum cart, liftgate, drum torque ratchet, etc)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Safe Acts / Behaviors (following BOGs, SOPs, JSAs, etc)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Correct Body Use & Position (Lifting/Pushing/Pulling/Bending)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Vehicle properly stocked with Emergency equipment and appropriate supplies

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Following applicable BOGs for service (No short cuts, lack of attention, etc)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Action

Select Satisfactory, Unsatisfactory, or Not Applicable for each question.

• Wears seat belt

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Maintains safe following distance

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Follows proper backing procedures (cone, spotter, etc)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Travels at safe speeds for conditions

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Checks mirrors frequently

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Use of cell phone or other equipment while driving

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Performs pre and post trip vehicle inspections

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

• Has driver's license and medical card on person

  Satisfactory

  Unsatisfactory

  Not Applicable

• Issue Statement

• Corrective Actions

Did the employee meet the following requirements. Select Yes, No, or Not Applicable for each question.

• Was PPE adequate for tasks being performed?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Is the Rep using mechanical advantage when available?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Is the Rep using proper lifting and body positioning techniques?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep back the truck in rather than pull in when possible?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep use a spotter if backing was necessary?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep have a properly working 30gal and 55gal drum dolly?
  

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep have adequate tools on the Route Truck to perform all basic services (impact wrench, spanner wrench, bung wrench, non-sparking tools)?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep unplug the machine and close the lid when completing the PW service?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep place a cone at the back of the truck?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was the COMS pump in good working condition with the switch NOT tied in th "ON" position? Is the grounding cable atttached and in good condition

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Is Rep maintaining a clean and orderly work area? Free of slips, trips, and fall hazards?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Are the straps on the truck in good condition?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the rep properly secure each load before proceeding?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Does Rep have proper knowledge and training of all SK equipment, products, and tasks being performed?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Are bungee cords being used on truck?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did Rep take time to identify any potential hazards before performing service? START Card?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep properly inspect and close each drum to ensure shippable condition and to prevent spills or leaks during transport?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did Rep provide the customer with a SDS for the solvent/solution and Operator’s Booklet for the parts washer at the time of placement?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did Rep use 3 points of contact when entering and exiting the vehicle?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Did the Rep bring along a Spare Uniform in truck as per PPE Policy?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was a first aid kit available on the truck?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was there an eyewash bottle available? Was it unexpired?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was the spill kit adequately stocked and placed where it could be easily reached?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was the respirator strored properly (clean, rigid container) and accessible?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Was the fire extinguisher properly secured? Has it been inspected monthly/annually?

  Yes

  No

  Not Applicable

• Comment

• Corrective Action

• Manager Comments

• Employee Comments:

• Employee Signature:

  Sign

• Select date

  Date

• Areas of Improvement:

• Positive Comments (What the employee did right):

• Conclusions (Why questionable actions occurred):

• Corrective Actions/Follow-up Measures:

• Observer Signature

  Sign

• Select date

  Date