E

Checklist (Forklift)

COMPANY: DATE: ____/____/________

Equipment Name: Equipment Serial No: Date:
3rd Party Certificate Detail: Operator Details-Name:
Certificate Issued Date: Operator 3rd Party Certificate No:
ValidTill: Expiry Date:
Operational Manual: Maintenance Log:

Item Motor Vehicles OK

NOT
N/A REMARKS
OK
1 Cleanliness
2 Seats&SeatbeltConditions
3 OperatorRestraintProvided
4 Instruments Operational&Labelled
5 Levers / ControlsOperational
6 Pedals in GoodCondition
7 Brake (Hand/Foot)
8 Clutch
9 Steering
10 Windows / Wipers / Washers / Mirrors
11 Front &Reversinglights
12 Warninglights / ReflectiveTriangle
13 Battery
14 Back Up Alarm
15 Horn
16 Rear View Mirrors
17 Fire Extinguisher / First Aid Kits
18 OperatorInstruction (available)
19 TurnIndicator
20 Reflective Orange Triangle
21 Handrails&Steps
22 Exhaust Instructions:
23 EngineGuarding 1.- Indicate with ‘Ok’ if ok; ‘N’ if not ok; ‘-‘ if not
24 Drivers free from leaks (Oil, Coolant, Fuel…) applicable.
25 Transmission Control 2.- This checklist must be kept in the vehicle
26 Tyres, Front, Rear, Brakes until the end of the week. After the last day (=
27 Wheel Mounting, Studs, Nuts Sunday), the checklist must be signed by the
28 Parking Break Equipment Operator and verified by the
29 Emergency Break Supervisor. The filled out form shall be filed by
the relevant department
 SAP U & E Monthly Safety Inspection Checklist (Forklift)

Item SpecificEquipment OK
NOT
N/A REMARKS
OK
1 Lifting:
2 Pivots
3 Connections
4 Safety Pins
5 Slings, Ropes&Chains
6 Rollers
7 Lifting Arms
8 Lifting tower
9 Bridge Base
10 TiltCylinder
11 Counterweight
12 Move and Hoist Control
13 State of Rops and Fops (Roll and Crush)
14 Availability of pallets and straps to secure the
15 WarningDevices:
16 Horn
17 MotionAlarm
18 FlashingAmberBeacon
19 Hydraulics:
20 Cylinders&Hoses
21 Connections (check for excessive wear, leaks and
22 Non-returnvalves Instructions:
23 OtherDevices: 1.- Indicate with ‘Ok’ if ok; ‘N’ if not ok; ‘-‘ if not
24 Exhaust applicable.
25 EngineGuarding 2.- This checklist must be kept in the vehicle
26 Steering Wheel until the end of the week. After the last day (=
27 Workplace (BeforePosting): Sunday), the checklist must be signed by the
28 Resistant soil, regular and controlled slope Equipment Operator and verified by the
29 Beware a Safe Distance to the Proximity of Supervisor. The filled out form shall be filed by

Remarks
Operator Safety Competent
Name and Officer * Person**
Signature Name and Name and
Signature Signature

* Is not needed Safety Officer’s signature in a daily basis is only to verifying operator's proper checking

** Competent person’s signature is needed in a monthly basis only