"*" indicates required fields

MM slash DD slash YYYY

Hazard Assessment

Controls

Road Conditions: Drive to road conditions, eliminate distractions, be aware of our surroundings and soft ground, follow applicable traffic laws.
Work Environment: Housekeeping, clean up work area, regular breaks and/or lots of fluids, proper clothing, hearing protection.
Controlled Products: Ensure proper WHMIS labeling, SDS available, training, proper storage and/or containment, PPE.

Severity

1
Death or permanent injury
2
Serious injury, illness, or major property damage
3
Non-serious lost time, injury, illness, or minor property
4
Minor injury/illness with no lost time
5
Negligible violation of standard/process

Probability

A
Probable
B
Reasonably probably
C
Remote
D
Extremely remote

Pre-Trip Inspection (External)

Shock, Springs*
Air Bags, Blocks*
Exhaust System*
Hose & Fittings*
Box/Tarp Condition & Security*
Tires*
Wheels, Hubs, and Fasteners*
Frame and Cargo Body*
Lamps and Deflectors*

Pre-Trip Inspection (Fluid Levels & Leaks)

Engine Oil*
Coolant*
Windshield Washer*
Brake/Clutch*
Power Steering*
Fluid Levels*

Pre-Trip Inspection (Air Brake System)

Low Air Warning*
Air Lines*
Performance/Adjustment*
Air Leakage*
Service Brake*
Parking Brake*
Trailer Brake*

Pre-Trip Inspection (Inside The Cab)

Seat & Seat Belts*
Insurance & Registration*
Hydraulic Controls*
Horn*
Steering*
Driver Controls*
Emergency Equipment*

Pre-Trip Inspection (Notes)

This field is for validation purposes and should be left unchanged.