Information

  • Document No.

  • Conducted on

  • Prepared by

  • Location

Driver Information

  • Driver Name

  • Route Number

DOT Inspection Book/Log Book

  • Driver logged into Samsara ?

  • Logged into DSDI?

  • Logged into GreenMile

  • EDVIR pre trip completed?

Driver Appearance/PPE

  • Driver in proper uniform?

  • Uniform (no rips/not able to snag).

  • Wearing slip resistant shoes with a safety toe?

  • Wearing safety gloves?

Driving Habits

  • Driver refrains from using a hands free electron device while operating a company vehicle?

  • Driver refrains from using personal electronic devices?

  • Follows driving a laws and regulations?

  • Driver refrains from using phone/texting while driving?

  • Maintains appropriate speed?

  • Maintains proper lane discipline?

  • Maintains appropriate following distance?

  • Driver refrains from eating, drinking, smoking. Not distracted

  • Courteous to other drivers?

Backing

  • Safe backing performed?

  • G.O.A.L- Get Out And Look used if necessary?

  • Drive announced intentions before backing? Honked Horn?

Product Delivery

  • Delivery made within customers delivery window?

  • Operates pallet jack safely ( horn, walks to the side)?

  • Driver bends at the knees to open the trailer door?

  • Driver uses door control and closed the trailer door after taking a pallet off?

  • Positions pallet jack to minimize obstruction?

  • Shrink wrap or pallet band stowed out of the way to avoid a tripping hazard?

  • Milk pallets placed neatly in cooler?

  • Credits/ Buybacks issued?

  • All empty cases picked up?

  • All empty pallets picked up

  • Invoices stamped & Signed?

Trailer Appearance

  • Product and empties properly staggered in trailer for even weight distribution?

  • Load properly secured?

  • Pallets stacked safely?

  • Pallet jack safely stowed?

  • Dock plate picked up and safely stowed

Tractor Appearance

  • Tractor cab clean?

  • Safety binder in tractor?

  • Spill Kit in tractor?

  • Fire Extinguisher present and secured?

  • Tractor doors are locked while delivery is being made?

Supervisor Signature

  • Add signature

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.