Material Handling Safety Inspection
Site
Date/Time
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
24-Hour Time Minutes
Safety Inspector
First Name
Last Name
Foreman/Lead
First Name
Last Name
Machine #1 Operator
First Name
Last Name
Machine #1
Machine #2 Operator
First Name
Last Name
Machine #2
Machine #3 Operator
First Name
Last Name
Machine #3
Job Safety Briefing performed for the crew?
Acceptable
Marginal
Unacceptable
N/A
N/O
Job Hazard Analysis performed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Does the JHA Process Form match the work?
Acceptable
Marginal
Unacceptable
N/A
N/O
Is the JHA Form complete and with hazards and mitigation?
Acceptable
Marginal
Unacceptable
N/A
N/O
Forklift Operator has competency?
Acceptable
Marginal
Unacceptable
N/A
N/O
Spotter used when forklift is operating?
Acceptable
Marginal
Unacceptable
N/A
N/O
Forklift has daily inspection completed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Forklift maneuver area clear?
Acceptable
Marginal
Unacceptable
N/A
N/O
Roof landing area has spotter?
Acceptable
Marginal
Unacceptable
N/A
N/O
Loads are properly secured for movement?
Acceptable
Marginal
Unacceptable
N/A
N/O
Loads are properly separated from packaging using safe techniques?
Acceptable
Marginal
Unacceptable
N/A
N/O
PPE matches the cutting device?
Acceptable
Marginal
Unacceptable
N/A
N/O
Packaging is secured from becoming wind driven?
Acceptable
Marginal
Unacceptable
N/A
N/O
Carts are properly used on highways?
Acceptable
Marginal
Unacceptable
N/A
N/O
Heavy loads are team lifts?
Acceptable
Marginal
Unacceptable
N/A
N/O
Solar panels are team lifts?
Acceptable
Marginal
Unacceptable
N/A
N/O
Long (over 6-foot) sections are team lifts on roofs?
Acceptable
Marginal
Unacceptable
N/A
N/O
Roof membranes are protected from storage?
Acceptable
Marginal
Unacceptable
N/A
N/O
Slings and chains inspected?
Acceptable
Marginal
Unacceptable
N/A
N/O
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