Vehicle Reversing Safety Checklist
Complete this checklist before reversing any vehicle to ensure all safety procedures are followed.
Vehicle Information
Provide details about the vehicle being reversed.
Vehicle Registration Number
*
Vehicle Type
*
Please Select
Truck
Van
Car
Forklift
Other
Operator Name
*
First Name
Last Name
Date and Time of Checklist
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reversing Area Conditions
Assess the area and surroundings before reversing.
Is the reversing area clear of people and obstacles?
*
Yes
No
Are all mirrors and cameras clean and properly adjusted?
*
Yes
No
Is a reversing alarm functioning?
*
Yes
No
Not Applicable
Is a trained spotter present (if required)?
*
Yes
No
Not Required
Checklist - Please indicate the status of each safety item before reversing.
*
Rows
Checked
Not Checked
Not Applicable
Warning lights operational
1
2
3
Horn tested
4
5
6
Area behind vehicle inspected
7
8
9
Reversing path free of obstructions
10
11
12
Weather conditions checked
13
14
15
Communication with spotter established
16
17
18
Additional Comments or Observations
Operator Signature
*
Submit Checklist
Submit Checklist
Should be Empty: