Working copy Al

• Document No.

• Route and Driver

• Conducted on

  Date

• Prepared by

• Location
  Address

Driver's Behaviors: Backing up, Driving, Pre-inspections and dumping procedures.

• If there was a helper on the back did the driver stay under 10 mph in between stops?

  Yes

  No

  N/A

• Did the driver stay in the truck?

  Yes

  No

  N/A

• Did they use three points of contact entering and exiting ?

  Yes

  No

  N/A

• Did the driver back up?

  Yes

  No

  N/A

• Can the route be changed to avoid back up?

  YES

  NO

• Did the driver back up with a helper?

  Yes

  No

  N/A

• Did the helper get off the step before the driver started backing up?

  Yes

  No

  N/A

Safe helper behaviors

• Was there a helper on the step while driving?

  Yes

  No

  N/A

• Did they use 4 points of contact using the PROPER HAND bars or openings at ALL TIMES?

  Yes

  No

  N/A

• Did the helper lift with his legs with a straight back?

  Yes

  No

  N/A

• Did the helper keep to the side of the truck when they cycled the hopper?

  Yes

  No

  N/A

• Is the helper wearing correct reflective vest

  Yes

  No

  N/A

• Is vest in good repair and worn correctly

  Yes

  No

  N/A

Route and stop evaluation

• Is the route timed?

  Yes

  No

  N/A

• Does the route include a school zone

  Yes

  No

  N/A

• Are pick up times adjusted to avoid peak traffic

  Yes

  No

  N/A

• Does the route require crossing traffic?

  Yes

  No

  N/A