Sysco Louisville, Inc. Perfect Lift Quick Assessment

• Employee Name

• Conducted on

  Date

• Prepared by

Watch the employee as they perform their normal job duties that require lifting. Assess the following perfect lift elements

• Pallet Positioning (distance between start and finish give them room to move their feet)

  Safe

  At Risk

  N/A

• Material Positioning at Start (raising it up or pulling it towards them before lift)

  Safe

  At Risk

  N/A

• Foot Positioning (feet facing the product and moving during lift)

  Safe

  At Risk

  N/A

• Material Positioning during Lift (holding it close to body)

  Safe

  At Risk

  N/A

• Back Positioning (back bowed in)

  Safe

  At Risk

  N/A

• Use of Legs (squatting down, bending knees)

  Safe

  At Risk

  N/A

• Avoids Twisting

  Safe

  At Risk

  N/A

• Conducts a relief stretch after an awkward lift

  Yes

  No

  N/A

Signature

• Employee

  Sign

• Supervisor

  Sign