Specific location / task:
Date:
Department(s):
Assessor:
Assessment guideline :
For this LIFEsaver Field Check, two drivers of mobile equipment and two pedestrians must be
interviewed. Complete a field observation of at least one person, but preferably two people driving
mobile equipment. Do a review of an (un)loading location or warehouse.
Interview/Discussion items :
Driver of mobile equipment
Do employee interviews verify mobile
equipment training and authorization
or certification?
Are regular inspections required and
who does these?
What would you do if you find a defect
in the mobile equipment?
Are you allowed to use mobile phone,
radio/music with earphones or walkie-
talkie while driving?
What/where are you focused on when
operating industrial vehicles?
Are seat belts available and do you
always use these?
Are you allowed to carry passengers
when operating the equipment?
What are the procedures for safely
accessing a transport truck with a
forklift truck?
Pedestrian
Have you, as a pedestrian, been trained
about the hazards walking near mobile
equipment and site traffic rules?
Warehouse: Are there special rules for
walking in the warehouse?
Expected Response Driver - 1 Driver - 2
Yes, done before allowed
operating mobile equipment,
and yearly refreshers.
Daily pre-use inspection, done
by the driver.
Immediately stop using / not
start using the equipment and
report the defect.
No, never allowed.
The road and/or drive direction
are free of obstacles, alert for
pedestrians and other traffic.
Yes, always.
No, unless the cabin is designed
for and equipped with extra
seat with seat belt.
Wheels chocked (or a dock
lock), dock plate in place,
device to prevent truck driver
from pulling away from the
dock until authorized, etc.
Expected Response Pedestrian - 1 Pedestrian - 2
Yes, and I always use the
designated walkways.
Stay on the walkpath, give
right-away for forklift trucks
and never walk under the load.
Stay out of restricted areas.
Field Observation Items :

Is a pre-use inspection performed and documented daily for the mobile

equipment?  Safe  At-Risk
Comments:

Are safety devices on mobile equipement (warning lights, backup alarms,

pedestrian proximity detection) working correctly?  Safe  At-Risk
Comments:

Does the driver show safe driving behaviors (speed, wearing seatbelt, etc.)?  Safe  At-Risk
Comments:

Are trucks protected from movement while being loaded

(chocks, dock restraint devices e.g. dock-locks)?  Safe  At-Risk
Comments:

Are drivers properly protected when working with mobile equipment

(feet / arms inside the cabin, driver protected to falling loads, etc)?  Safe  At-Risk
Comments:

Review warehouses, intersections, truck unloading and truck staging areas:

Are designated walkways available and used correctly in warehouses and

truck staging areas?  Safe  At-Risk
Comments:

Are pedestrians and operators protected by means of fixed barriers at critical

intersections and truck unloading areas?  Safe  At-Risk
Comments:

Follow up items Deep Dive assessment

required (yes/no)
1
2
3
4

Guideline for “Deep Dive” determination :

Drivers of mobile powered equipment indicate that they were not trained.
Seatbelts are not available or not always used.
Both pedestrians indicate that they were not trained about the site traffic rules.
Pre-use inspections on mobile powered equipment are not preformed.
At-risk driving behaviors observed. At-risk operator / pedestrian situations at intersections, truck
unloading and truck staging areas, no walkpath for pedestrian available in warehouses.