Aerial Platform Evaluation

• Client / Site

• Conducted on

  Date

• Evaluator:

• Operator:

• Location
  Address

Familiarization of Equipment

• 1- Knows and checks location of manual

  Yes

  No

  N/A

• 2- Performs visual inspection

  Yes

  No

  N/A

• 3- Performs function test

  Yes

  No

  N/A

• 4- Understands workplace inspection (gives example of what to look for: overhead obstructions, debris or holes in floor)

  Yes

  No

  N/A

• 5- Knows how to don and doff fall protection harness

  Yes

  No

  N/A

• 6- Understands spotter or cones must be used anytime operator is on lift

  Yes

  No

  N/A

• 7- Knows safety devices and operating characteristics specific to lift

  Yes

  No

  N/A

• 8- Knows purpose and function of all controls

  Yes

  No

  N/A

• 9- Understands scissor lift can never be used outside (transport only)

  Yes

  No

  N/A

• 10- Understands that everyone in lift must be trained or operator takes full responsibility for the rider

  Yes

  No

  N/A

• 11- Understands that materials and operator can NEVER exceed lift rated capacity

  Yes

  No

  N/A

• 12- Understands fall protection harness must be proper size for operator

  Yes

  No

  N/A

• 13- Understands that pre-use inspection must be completed before each shift minimum

  Yes

  No

  N/A

• 14- Understands that all incidents must be reported to EH&S Manager

  Yes

  No

  N/A

• 15- Understands that if any defects are found during inspection or operation, operator must discuss with EH&S Manager or Operations Manager

  Yes

  No

  N/A

Evaluation of Driving Ability

• 16- Performs smooth operation

  Yes

  No

  N/A

• 17- Starts and stops smoothly

  Yes

  No

  N/A

• 18- Raises and lowers lift smoothly

  Yes

  No

  N/A

• 19- Swing control smoothly

  Yes

  No

  N/A

• 20- Knows where to park lift

  Yes

  No

  N/A

• 21- Knows where and how to hook up charge unit

  Yes

  No

  N/A

• Operator

  Sign

• Evaluator

  Sign