Sysco Cleveland Safety Lane

• Driver Name

• Observation Type

  Select 30 Day 60 Day 90 Day Post Incident Quarterly Safety Lane

  • 30 Day
  • 60 Day
  • 90 Day
  • Post Incident
  • Quarterly
  • Safety Lane

• Conducted on

  Date

• Prepared by

• Location
  Address

• Route Number, Tractor Number & Trailer Number

General Assessment

• Driver is properly uniformed for work and is clean and neat

  Yes

  No

  N/A

• During the observation, driver exhibited a positive and safe attidue

  Yes

  No

  N/A

• Drive is aware of his surroundings at all times

  Yes

  No

  N/A

• Pictures

  Media

DOT/Safety Checklist

• Seatbelt and Directional Entering the Yard

  Yes

  No

  N/A

• Three Point Stance

  Yes

  No

  N/A

• Valid Medical Card

  Yes

  No

  N/A

• Valid CDL

  Yes

  No

  N/A

• Valid Vehicle Registration

  Yes

  No

  N/A

• 2016 Accident Kit

  Yes

  No

  N/A

• Valid Insurance Card

  Yes

  No

  N/A

• Telogis Law Enforcement Card

  Yes

  No

  N/A

• FMCSR Book - Must be dated February 2016 or later

  Yes

  No

  N/A

• 2012 ERG Book

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

• Reflective Triangles

  Yes

  No

  N/A

• Fire Extinguisher - Charged and Secured

  Yes

  No

  N/A

• DVCR Book

  Yes

  No

  N/A

• Log Book

  Yes

  No

  N/A

• Cab Clean

  Yes

  No

  N/A

• Able to Recite Smith Keys and GOAL

  Yes

  No

  N/A

• Valid Tractor Annual Inspection

  Yes

  No

  N/A

• Valid Trailer Annual Inspection

  Yes

  No

  N/A

Comments & Signature

• Comments

• Employee Signature

  Sign

• Supervisor Signature

  Sign