Page 42 - Powered Industrial Trucks

P3 Safety Solutions, LLC Powered Industrial Trucks - Operators (1910.178)

SAMPLE ----------Fork Truck
Pre-Operation Inspection Checklist

Date Shift Truck Number
Supervisors Name ______________________________

The fork truck that I was assigned is unsafe to operate because of the following safety
defects:

 Service Brake  Lift Control
 Parking Brake  Fluid Levels
 Steering  Tilt Control
 Horn  Limit Switches
 Lights  Hydraulic Cylinders
 Tires and Wheels  Hydraulic Hoses and
Fittings
 Overhead Guard  Other
 Forks, Mast, Chains, Stops,
Backrest

Operator’s
Name

This vehicle should not be operated with these defects. What do you want me to do?

(White) Employee  (Yellow) UAW Safety Committee  (Pink) Supervisor

opeiu494afl-cio
12/19/2013 Publication # 31

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