Note: Fields with ( * ) are to be filled compulsory.

• 00:00:00
• Tech Name *
• Email *
• Branch *NashvilleChattanoogaNorth GAKnoxvillePiney FlatsCookevilleTullahomaClevelandLavergneLondonBranch *
• Date *
• Time *
• Workorder Number *
• Lift EQ or Serial *
• Job Task being performed *
• Personal Protective Equpment Required *

  Safety Glasses

  Gloves

  Hard Hard

  High-Vis Vest

  Facesheild

  Safety Shoes
• Pre-Task Review *

  Job reviewed and understood

  Proper tools and equipment available

  Safety Data Sheets (SDS) available for chemicals

  Working Conditions are safe

  Trained for the task

  Area around forklift coned off
• Hazard Identification *

  Pinch points and sharp edges identified

  Moving parts secured or de-energized

  Fluids (oil/hydraulic) handled with care and cleanup equipment readily availible

  Electrical hazards assessed

  Ladders, Jacks, and blocks inspected (if needed)

  Work area clear of slip, trip, or fall hazards
• Lockout/Tagout (LOTO) *

  Required for this job? Check if Yes

  Equipment turned off and isolated

  Lock and tag applied

  Verification of de-energization completed
• Post-Task Safety *

  Repairs completed safely

  Area cleaned and tools stored properly

  Spills cleaned and materials disposed properly
• Any unforseen safety issues encountered. If so, how did you fix it and how can it be prevented? *
• Submit