Forklift Compliance Checklist

FORKLIFT COMPLIANCE CHECKLIST

Employee: Date:

Forklift Make: Model: Serial No: Unit No:

Other: other:

Business Unit: Sub-Business Unit:

Location: Instructions for Completion: 1. All items to be inspected on initial deployment of equipment; and “*” items to be inspected weekly. 2. Inspections should be performed jointly and signed off by the EnCana and Contractor representatives. 3. Forward a copy of this report to the Business Unit EHS Coordinator.

Status Codes: S = Satisfactory X = Unsatisfactory NA = Not Applicable

Inspection Item Comments Status LOAD HANDLING DEVICE Manufacturer’s Specification Plates 1. Truck plate 2. Attachment plate 3. Information shown on the capacity plate matches the truck, mast, and currently installed attachments

Forks 4. Record for length, width, and thickness 5. In accordance with manufacturer’s specifications (note any unauthorized cutting, cracks and heel wear) 6. Straightness of blade and shank 7. Fork angle 8. Fork tip height and condition 9. Tube condition 10. Welded areas 11. Blade and heel 12. Hook mount forks 13. Shaft mount forks 14. Special forks 15. Attachments to forks 16. Latch pins (where originally provided)

Attachments 17. Visual and operational check 18. In accordance with manufacturer’s specifications 19. Attachment mounting 20. Load bearing arms (straightness and twists) 21. Pivot points and hinges 22. Hanger brackets 23. Latch pins 24. Stops 25. Load backrest position

Movement 26. Carriage free and unobstructed 27. Anchors 28. Stub shafts 29. Bearings 30. Weldments/ forkbars

ELEVATING SECTION Lift Chains 31. Anchors 32. Guards 33. Elongation 34. Wear (with wear gauge) 35. Adjustment (as per manufacturer’s specifications)

1 of 4 Inspection Item Comments Status Mast 36. Visual and operational check of mast operation 37. Mast mounting, bushings and pivots 38. Rails 39. Straightness 40. Wear 41. Cross bracing 42. Pins 43. Chain guide rollers 44. Wear strips and guides 45. Hoses, pulleys, and fittings 46. Latches - stops

Hydraulic System 47. Lift cylinders 48. Anchors 49. Piston head guides 50. Lines 51. Leaks 52. Drift test 53. Tilt cylinders 54. Racking 55. Rod end retainer 56. Tilt angle (degrees) 57. Set hydraulic pressure relief valves 58. Lift/ lower levers – identified and in good condition

Welds and Fasteners

PROPULSION SYSTEM Brakes 59. Test Operation 60. Wheel cylinders 61. Master cylinder 62. Brake lines

Tires 63. Check tire pressure for load-rating capacity 64. Check for damage, wear, and missing hardware

Battery 65. Minimum allowable weight from manufacturer’s specs 66. Battery weight 67. Battery position 68. Battery restraining devices 69. Leaks

Counterweight 70. Mounting 71. Unauthorized additions or missing weights 72. Cracks

GENERAL SAFETY Transmission

Tires 73. Driving and steering characteristics 74. Bonding

Steering 75. Check steering wheel for physical damage 76. Check steer axles and box 77. Operational check of wheel bearings

Overhead Guard 78. Secured 79. Breaks or cracks 80. Missing Pieces 81. Modifications

2 of 4 3 of 4 Inspection Item Comments Status Propane Equipment 82. Fuel tank mounting system secure 83. Fuel tank position pin intact 84. Check propane relief valves 85. Check hose condition

Other 86. Check fail-safe components of electrical controls 87. Warning devices (lights, bells, whistles, horns, etc.) 88. Engine operation and emissions 89. Seat (secure, belts) 90. Seat and handle switches 91. Fuel leaks

ACTION PLANS (Priority Code Legend: 1 – Emergency 2 – Urgent 3 – Not Urgent 4 - Routine ) Completed Action Items to be Completed Priority Person Assigned to Task Target Date Yes No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 . 13 . 14 . 15 .

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