Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Auditor Employee Number

  • Time

  • Airline

  • Station

  • Gate Number

  • Aircraft number

  • Aircraft Type

WEAR PPE - ( Ear Protection/Safety Vest)

  • Safety vests worn properly

  • Hearing protection worn

  • PPE used during lav service; other

  • Other

Safety zone clear

  • Proper use of belt loader

  • Proper use of bag tug

  • Proper use of bag cart

  • Proper use of lav truck

  • Proper use of tow bar

  • Proper use of chocks

  • Agent procedures followed

  • Towbar hooked up with A/C engine not running

  • Ground service air hose used properly

  • Agent streching electric cord while A/C has stopped

  • Other

Aircraft chocked properly

  • Used two chocks

  • 24 inch Chocks used

  • Chocks used at appropriate angles

  • Main gear chocked (terminator)

  • No Gaps left causing A/C rollback

  • Other

Proper hand signals used

  • Wands used

  • Correct wands used

  • Proper hand sequence used

  • Used only known hand signals

  • Agent in position

  • Other

Gate services procedure followed

  • Ground electric used

  • Electric connected only after AC chocked

  • Cord not placed under towbar

  • Ground air used

  • Other

Towbar connected according to procedures

  • Two agents hooking up towbar/pushback

  • Agent seated while aligning push back

  • Agent does not lift bar while pushback is approaching

  • Other

Fwd/Aft Lavs completed according to procedures

  • Fwd lavs completed

  • Fwd flush carried out;

  • Aft Lavs completed

  • Aft not flush carried out

Walkaround

  • Walkaround complete prior to push:

Guide agent following procedures

  • Agent in correct position for push back

  • Not on blind side of push

  • Walking towards pushback at proper time

  • Agent using correct wands

  • Wands held in front of agent

  • Other

Proper driving procedures followed

  • Did not drive under wing/tail

  • Equip was not driven between Marshaller & taxing A/C

  • Bags not transported on tugs

  • No tug in safety zone without beltloader present

  • Agent did not chase towbar

  • Driving at proper speed

  • Pulling only max carts or less

  • Not Used at Gate

MP3/cell phone policy followed

  • Not Used while driving in ramp area

  • Not used while driving on service road

  • Not used at gate

FOD

  • FOD walk completed prior to A/C arrival and push

  • FOD present in general ramp area

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.