Vehicle Movement Risk Assessment Checklist Form
Evaluate the safety risks of your planned vehicle movement using this concise assessment checklist.
Type of Vehicle Movement
*
Delivery
Passenger Transport
Equipment Transfer
Other
Route Condition Assessment
*
Rows
Low Risk
Medium Risk
High Risk
Traffic Volume
1
2
3
Road Surface
4
5
6
Weather Conditions
7
8
9
Vehicle Pre-Use Inspection Completed?
*
Yes
No
Driver Fitness and Authorization
*
Fit and Authorized
Fit but Not Authorized
Not Fit
Are there any known hazards identified along the planned route?
Construction Zones
Sharp Turns
Pedestrian Traffic
Other
Risk Level for This Movement
*
1
2
3
4
5
Control Measures in Place
*
Journey Plan
Communication Devices
Spotter Assigned
PPE Required
Other
Estimated Departure Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Supervisor Review Required?
*
Yes
No
Additional Comments or Observations
Submit Assessment
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