Title Page

  • Driver name

  • Unit number and plate number

  • DVIR completed prior to trip?

  • Location

  • Weather conditions

  • Conducted on

  • Prepared by

  • Document No.

Observation

Safe Driving

  • Medical card in possession? ( include expiration in comments)

  • Driver license and or CDL in possession? ( include expiration in comments)

  • Drives appropriate speeds for the conditions?

  • Keeps appropriate following distance between vehicle? (Key#1 Aim high in steering, Key#2 Get the big picture)

  • Changes lanes safely? (Use of turn signals)

  • Drives on correct side of the street? (No snaking)

  • Slows when approaching intersection? (Key#3 keep your eyes moving check mirrors every 8 seconds)

  • Yields to right of way when necessary?

  • Driver leaves themselves a out? (Key#4 leave yourself a out)

  • Stays out of blind spots? (Key#5 make sure they see you)

  • Turns from correct lane?

  • Uses turn signal properly?

  • Slows/Stops carefully?

  • Aims high in steering to time the red lights to avoid coming to a complete stop?

  • Parks vehicle properly and scan ahead to select safest possible parking location?

  • Obeys all traffic laws?

  • Headlights on when vehicle is in use at all times?

  • Uses 4 way beacon light when collecting?

  • Uses seat belts as required? ( must remain buckled until vehicle come to a complete stop)

  • Uses 3pt contact when entering vehicle and exiting vehicle?

  • Secures load? ( Ro 3pt securement and tarps)

  • Unloads vehicle safely?

  • Follows rule prohibiting scavenging?

  • Turns off truck to avoid leaving it idle?

Vehicle condition

  • Current state and/or Federal inspection sticker on vehicle and current registration?

  • Headlights, windshield, mirrors, and lights are clean and in good working condition?

  • Cab clean and free of loose objects?

  • Rear vision system operational?

  • Camera monitors are clean and visible?

  • All alarms (visible and audible) are in working condition per SWACO and vehicle requirements?

  • Reflective triangles and spill kits present and in good condition?

  • Hydraulic controls labeled as to functions?

  • Body access door interlock installed and working?

  • Lockable battery disconnect installed?

  • Fire extinguishers accessible, mounted, charged, and displaying annual inspection?

  • Behind blade and above blade clean?

  • All lights operational on vehicle including strobes, mid body turn signals, taillights,marker lights and reverse lights?

  • Tires in good condition and meet SWACO standards?

  • Reflective tape if present, is in good condition?

  • Rear step ANSI compliant and undamaged?

  • Back up alarm functional?

  • License plate visible, and light is in working condition?

  • Was DVIR completed pre-trip and post trip?

Personal Safety

  • Hard hat as required?

  • 6" High steel toe work boots?

  • ANSI Class 2 Vest and Clothing outermost garment?

  • Safety Glasses being worn as required?

  • Proper container handling?

  • Proper lifting techniques? (bends at knees and lifts not with the back)

  • Conforms to SWACO cell phone, ear bud and electronics policy?

Supervisor/Safety comments and signatures. Driver/Employee comments and signatures.

  • Drivers comments:

  • Drivers signature:

  • Supervisor/Safety comments:

  • Supervisor/Safety signature

  • Corrective action required? ( Explain any action and date when to be completed by)

  • Add any Pictures Relevant to Observation

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.