Scottys III Observation Form

Title Page

Type: New / Review / Follow Up
Forklift #, Make/Model
Years Experience of Driver
Name of Observer
Name of Observed
What time did you start audit?
What date was last observation of this person conducted?
Has you reviewed the previous observation of this person before starting this one?

Before Operations

6. Operator uses 3 point contact when getting on and off the lift?
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7. Forks are lowered and placed on the floor when leaving the forklift?
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8. Parking brake is always set before leaving the forklift?
9. Forklift is switched off and key is maintained in specified place when ending operations?

10. Forklift path is checked for obstructions before proceeding on the forklift?
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11. Quick starts and/or stops are not performed?
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12. Specified speed limit is followed?
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13. Material has been checked for any damages or unstable stacks?
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14. Loads on pallet are transported after confirming that the load is stacked safely and in stable condition?
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15. Forklift is paused and position of the forks are confirmed before inserting forks?
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16. Forks are in the pallet properly?
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17. Loads are lifted/lowered correctly without movement of wheels on lift?
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18. Forklift is not driven with loads higher than 4-6 inches from the surface?
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19. The forklift mast is tilted back to maintain loads during operations?
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20. The operator drives in reverse when the view is obstructed?
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21. Operator stops and sounds horn at intersections?
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22. Unsafe behavior such as riding on the trucks or mast is not performed?
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23. Product is loaded and stacked properly during the loading/unloading process?
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24. No single item is loaded that exceeds the back rest that is considered to be unsafe for travel?
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25. All dock constraints are utilized during the loading/unloading process?
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26. Operator knows stack height and travel height of items (s)he is carrying at the time of questioning?
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27. Either witnessed or answered in questioning, operator knows required PPE for changing/charging fuel of lift they are operating?
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28. When asked, operator knows what to do in event of power outage in the building? (Stop lift and walk, don't drive lift)
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29. Seat belt worn at all times during operation of lift?
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30. No uncapped drinks present on forklift?
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31. Operator can demonstrate and describe inspection of lift?
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32. Operator can demonstrate and describe inspection of raise/lower?
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33. Operator can demonstrate and describe inspection of horn?
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34. Operator can demonstrate and describe inspection of tires?
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35. Operator can demonstrate and describe inspection of oil leaks?
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36. Operator can demonstrate and describe inspection of brakes?
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37. Operator can demonstrate and describe inspection of hour meter?
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38. Operator can demonstrate and describe inspection of mast chains?
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39. Ask operator for five safety rules to follow at loading/receiving dock. This can include chock wheels, operator safety, wear ppe, proper lighting, watch for others, warn others, hold handrail, glad hand, horn usage exiting trailer, other... List replies
40. Ask operator for five safety rules to follow at refueling stations. They can include proper ppe, plug/unplug procedures, no smoking, clean up procedures, msds, eye wash stations, shut off lift, other... List replies
What time did you end audit?