TX55 - HSE Gemba - Forklift or Rider Handling Equip

• Conducted on

  Date

• Prepared by

• Location
  Address

FLT or Rider operated handling equipment -

• Marked pedestrian walkways - are they clearly marked and suitable for walking to common areas. (Restroom, Breakroom, Conference Room, and offices)

  Yes

  No

  N/A

• Adequate pedestrian segregation / restriction - are pedestrians and lift drivers adhering to the floor markings?

  Yes

  No

  N/A

• Access restrictions during operations - are employees adhering to the rule of one activity in an aisle. (i.e. Picking with no cycle counting)

  Yes

  No

  N/A

• Blind spot elimination / mirrors - are all intersections and blind spots controlled by mirrors or warning lights?

  Yes

  No

  N/A

• Blue spot lights on FLT’s - did all of the Forklift Trucks have an operational blue light that you observed?

  Yes

  No

  N/A

• 5 mph max speed limited - Did all operators slow at intersections and at turns, sounding their horns to alert others?

  Yes

  No

  N/A

• Pre-use inspection completed and recorded - Stop at least 2 operators and ask to see their completed pre-use inspection from. Was all the data current and complete?

  Safe

  At Risk

  N/A

• Seat belt worn at all times - Did all operators observed have their seatbelt fastened?

  Yes

  No

  N/A