Safety Observation Report

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Observation On

Truck and location description

• Truck Number

• Location of Inspection
  Address

Driver Performance

• Is cargo secured

  Yes

  No

  N/A

• Looks for overhead power lines

  Yes

  No

  N/A

• Performs safe lane changes

  Yes

  No

  N/A

• Keeps a safe following distance

  Yes

  No

  N/A

• Performs job task correctly

  Yes

  No

  N/A

• Was wearing seatbelt at all times

  Yes

  No

  N/A

• Used 3 point contact when entering and exiting vehicle.

  Yes

  No

  N/A

• Was wearing company uniform as required

  Yes

  No

  N/A

• Was wearing Hard Hat outside the vehicle

  Yes

  No

  N/A

• Was wearing Eye Protection outside the vehicle

  Yes

  No

  N/A

• Was using hand protection outside the vehicle

  Yes

  No

  N/A

• Was wearing correct foot ware?

  Yes

  No

  N/A

• Correct procedures were followed at job site, landfill, or yard

  Yes

  No

  N/A

• Loading / Unloading Container Properly

  Yes

  No

  N/A

Truck Condition

• Reflectors are in good condition

  Yes

  No

  N/A

• Mud flaps are in place and in good condition

  Yes

  No

  N/A

• Wheels,tires are in good condition

  Yes

  No

  N/A

• Any Body Damage in need of Repair, If so, Immediately Schedule the Repair

  Yes

  No

  N/A

• Vehicle condition

  Select Clean Dirty

  • Clean
  • Dirty

Results

• Select date

  Date

• Add signature

  Sign