Safety Evaluation Sheet for Forklift

Supplier Name

Topic

1. Safety Standard

2. PPE Standard

3. Safety Equipment
Check

________________________________________
Item

Priority

In case of NG please be explain

the reason and countermeasure

1.1 Provided training course and driving license to operator

- Operator must pass training both classroom and practical training
- Operator have driving license, always show while operating (Easy to visual check)
- License must indicate issue date and expire date

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1.2 Provide repeated training course for operator every year

1.3 Have fix speed limited both production area and outside, have visual sign

1.4 Drive backward in case of material is higher than driver's vision

1.5 Lift up material by center gravity if can not set center gravity, must attach the
material to holding equipment by rope or chain

1.6 When parking forklift must

- Pull hand break --> Lower fork --> Turn off engine --> Take key off -->
Release safety belt

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(
)

- --> --> --> -->

1.7 Do not stand on raised pallet, walk or work under loaded

1.8 100% Fasten safety belt while driving

1.9 Prohibit other operator to passenger on forklift

1.10 If driving thru the junction and corner must to give sound signal

1.11 If driving on slope way not allow to use gear N (Neutral)

If working or parking on slope road must use chock to support wheel

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1.12 Separation between man and forklift

2.1 Have clearly PPE standard, mention in WI and operator follow standard
- Helmet with chin belt, Safety shoes, Safety vest for night shift

Condition
OK
NG

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- , ,

3.1 Daily check all equipment condition before working by check sheet that clearly
checking criteria

- Brake system /
- Hydraulic system /
- Fork operating function /
- Wheel and Tires /
- Electric system /
- Light signal (Turn, Backward, Rotary lamp) /
- Sound signal (Horn) /
- Battery status /
- In case of LPG, must check LPG tank, valve and tube /
LPG , ,

4. Leader / Manager
Patrol and Check

4.1 Daily patrol by leader

4.1.1 PPE of operator

4.1.2 Check operator driving license

4.1.3 Confirm daily check sheet of operator

4.1.4 Check parking condition

4.1.5 100% Fasten safety belt while driving

4.1.6 Check operator while working /

- Have holding equipment when loaded material /
- Not allow other operator to passenger /
- Fork position during forklift working / ,
4.1.7 Give sound signal when driving pass junction or corner

4.1.8 Forklift must park at the specific area after working time

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4.2 Week patrol by top management (Manager level up)

()

4.2.1 PPE of operator

4.2.2 Check operator driving license

4.2.3 Confirm daily check sheet of operator

4.2.4 Check parking condition

4.2.5 100% Fasten safety belt while driving

4.2.6 Check operator while working /

- Have holding equipment when loaded material /
- Not allow other operator to passenger /
- Fork position during forklift working / ,
4.2.7 Give sound signal when driving pass junction or corner

4.2.8 Forklift must park at the specific area after working time

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Due
Date