Aerial_Lift_Practical

• Evaluation Number

• Type / Model of lift or bucket truck used?

• Client / Site

• Conducted on

  Date

• Evaluation or Assessment conducted by.

• Location
  Address

Name of person being evaluated or assessed

• First Name

• Last Name

• Last four of SSN or Employee ID#

• Perform operator maintenance as required?

• Inspect vehicle propery, including frayed, worn fuel lines, hydraulic hoses, fuel, hydraulic, transmission or oil leaks?

• Knows hot to "Deadline" vehicle if it is unsafe to operate?

• Knows how to check oil properly?

• Knows how to check automatic transmission and hydraulic oil levels?

• Signs operator maintenance sheet/card?

Hazard assessent / recognition

• Can operator recognize site hazards for lift operation?

Bucket Truck or Mobile Lift

• Knows clutch operation?

• Does not spin tires; and start and stop smoothly?

• Does this operator exhibit the proficiency necessary to react to unusual or emergency situation?

• Does operator understand how equipment can easily overturn?

• Does operator move in a safe, efficient manner?

• Does operator know and demonstrate safe driving speeds for conditions?

• Does operator demonstrate knowledge of properly parking vehicle for short periods of time? And Leaving vehicle unattended?

Aerial or Worksite Manlift

• Does operator smoothly operate lift controls?

• Does operator smoothly operate travel controls?

• Does operator understand how emergency controls / shutdown works?

• Does operator know how to shut off equipment properly, including:

  Select Inspects vehicle for proper storage (eliminates tripping hazards, fire hazards, etc.) Removes key (if applicable) Completes after operation inspection if required

  • Inspects vehicle for proper storage (eliminates tripping hazards, fire hazards, etc.)
  • Removes key (if applicable)
  • Completes after operation inspection if required

• General Comments:

• I certify that this operator has performed the test items listed on this test form and it is my assessment that this operator is QUALIFIED to safely operate this equipment.

• I certify that this operator has performed the test items listed on this test form and it is my assessment that this operator is NOT QUALIFIED to safely operate this equipment.

• Evaluator Signature

  Sign

• Student Signature

  Sign