It's a good mix of twists. If you think of a plot twist as a "wow this changes everything" moment, well, not all of the entries are radical changes, but there's still a good mix. If you need a truly radical twist, you might need to reroll/redraw, or you might need to think up a way to turn a seemingly mundane event up to 11.
Each entry gets a title and a one-line description. The titles are often self-explanatory on their own. The descriptions are pretty clear about what the twist is. The descriptions leave room for interpretation, as they should. For example, when "extreme natural weather" crops up, it's on you to decide what sort of weather that is.
Most of the twists are genre-neutral. Several of them assume magic or the supernatural. All of the twists are game system-neutral.
Virtually all of the twists are suitable for a mid-adventure twist: twists that are revealed somewhere in the midst of the adventure. Some of them are suitable for the start of an adventure - things you could find out right off the bat (for example, learning that there's a great distance to travel). Only a few of them are suitable for end-of-adventure zingers (e.g., finding out there's no reward after you've accomplished your mission).
Some of them are good for unplanned, unexpected events, so it's no big deal to have them pop up randomly during an adventure. A change in the weather is one example. Other twists are revelations of something that should have been true all along, such as finding out you've been dealing with an imposter. Those might be better as planned twists instead of random twists, if you want to avoid the risk of creating inconsistencies.
The setting-specific dice roll columns are a nice touch. Each column is a d1000 column. The Random column gives you the full range of 150 twist types. The Underground, Wilderness, Large Urban Area, and Small Urban Area columns include only the applicable twists for locale in question. The User column is blank so you can write in your own list of probabilities for the entries you want to allow.
Including pages for printing the twists on business card stock is another nice touch. Using cards makes it fairly easy to exclude the cards you'd consider irrelevant. They recommend Avery 3612 printer stock, but it seems that Avery no longer offers the 3612 stock (8-up business cards). Avery has other 8-up business card stock now, but I haven't tried them with this PDF. The PDF includes a page of blank cards (blank except for the frame around the twist's text) in case you want to make up your own twist cards. There's also a page of card back images.