Assessment Checklist

• Job Number:

• Competency check list

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

OPERATOR DETAILS

• OPERATOR NAME

• EPIC/MQPC CARD NUMBER (if applicable)

• HEALTH & SAFETY TESTED YES/ NO<br>If NO date of last test:

  Yes

  No

  N/A

• COMPANY NAME Business Unit - Region - Area - Site

• EMPLOYER/EMPLOYEE REFERENCE No.

• TYPE OF CARD APPLIED FOR

  RED

  BLUE

CONFIRMATION OF AUTHORISATION TO DRIVE I confirm that I am authorised to drive the category of plant for the purpose of this assessment.

• OPERATOR SIGNATURE

  Sign

• DATE

  Date

ASSESSMENT DETAILS

• ASSESSOR NAME

• DATE OF ASSESSMENT

  Date
• ASSESSMENT LOCATION
  Address

• VEHICLE USED

• VEHICLE CATEGORY (Please select Bucket Capacity in Cubic Meters)

  Below 3.5 Cubic meters

  Below 7.5 Cubic meters

  Below 13 Cubic meters

  Above 13 Cubic meters

• WEATHER CONDITIONS ON ASSESSMENT

• PHOTO ID NUMBER (Photo must be supplied for an operator who does not have a current card, or where the existing photo is no longer a good likeness)

  Media

• WHERE THERE ANY FACTORS NOT ASSESSED? (If yes please select which factors were not assessed)

  Select NO all factors assessed 1 Daily Pre-Start Checks 2 Start up Procedures 3 Function Checks 4 Braking 5 Manoeuvring in Forward & Reverse 6 Filling the Bucket with Material 7 Travelling Empty and Loaded 8 Loading Hoppers 9 Loading Dump Trucks 10 Loading Road Vehicles 11 Working at the Face 12 Working with Attachments 13 Parking 14 Shut Down 15 Post-Stop Checks 16 Operational Safety

  • NO all factors assessed
  • 1 Daily Pre-Start Checks
  • 2 Start up Procedures
  • 3 Function Checks
  • 4 Braking
  • 5 Manoeuvring in Forward & Reverse
  • 6 Filling the Bucket with Material
  • 7 Travelling Empty and Loaded
  • 8 Loading Hoppers
  • 9 Loading Dump Trucks
  • 10 Loading Road Vehicles
  • 11 Working at the Face
  • 12 Working with Attachments
  • 13 Parking
  • 14 Shut Down
  • 15 Post-Stop Checks
  • 16 Operational Safety

• WAS THE OPERATOR COMPETENT IN ALL FACTORS OF THE ASSESSMENT ON WHICH THEY WERE ASSESSED?

  YES

  NO

1. Daily Pre-Start Checks (Walk Round Inspection)

• a) Wears correct PPE

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Vehicle safely isolated during pre-start checks

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Checks for external oil leaks

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Completes inspection of tyres including pressure & wheels for damage including rim locks

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Check steps, handrails, mudguards and cleans as necessary

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Checks general condition of body, cab & chassis for damage & defects

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Checks ROPS structure for damage, integrity & mountings (If fitted)

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Windows & mirrors checked for damage and cleaned

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• i) Carries out fluid level checks to manufactures specifications & machine design

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• j) Checks pipes and hoses for leaks, chaffing & damage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• k) Checks engine & fuel system for leaks & contamination

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• l) Checks alternator drive belt tension and condition

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• m) Checks and if required cleans cooling radiator

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• n) Checks security of battery, terminals for condition, & wiring for damage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• o) Checks hydraulic gear & bucket for damage & wear, weld & joint defects

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• p) Checks quick hitch couplers ( if applicable)

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• Specify type

  Semi-automatic

  Manual

  Automatic

• q) Carries out prescribed Autolube system lubrication procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• r) Carries out prescribed manual greasing lubrication procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Please state system

  Autolube system

  Manual greasing

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• s) Checks visibility aids (and adjusts and cleans as necessary)

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• Specify type

  Select Mirrors Camera Radar Other

  • Mirrors
  • Camera
  • Radar
  • Other

• Please state

• t) Checks seatbelt for condition & security

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• u) General good housekeeping of vehicle

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• v) Check air tank valve is closed (If applicable)

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• w) Correctly completes daily check sheet or reports appropriately

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• x) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

2. Start Up Procedures

• a) Sets up and adjusts seat as necessary

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Applies seat restraint

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Checks instruments, gauges and monitoring displays

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Able to report on the significance of each condition monitoring device and instrument reading symbols

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Checks audible warning devices

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) All condition monitoring devices indicate correct functions before moving off

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Disengages hydraulic safety control device

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Checks function and accessibility of all reversing aids

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• i) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

3. Function Checks

• a) Power unit / Transmission / Steering / Brakes / Hydraulics / Electrics

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Emergency or secondary systems ( Steering and Brakes)

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Company checks and paperwork completed.

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

4. Braking

• a) Checks brakes daily to unit test procedure and reports faults

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Braking procedure is carried out to meet operating conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

5. Manoeuvring in Forward and Reverse

• a) Displays high degree of manoeuvrability in confined spaces - flat and gradients

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Adherence to site rules at all times whilst manoeuvring

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Displays correct use of reversing mirrors and other reversing aids/ maintains good visual awareness

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Machine stationary before selecting forward and reverse gears

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Keeps reversing down to a minimum

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Selects the right gear to meet operating and environmental conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

6. Filling the Bucket with Material at bays/ stockpiles

• a) Approaches material square on with bucket in correct position

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) follows correct procedure to fill bucket avoiding wheel spin

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Maintains bucket capacity avoiding spillage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Avoids contamination when working with different materials

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Displays sensitivity of use of hydraulic controls according to working conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Observes face conditions of stockpiles

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Carries out working at tips and stockpiles according to site rules/ safe systems of work

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

7. Travelling Empty and Loaded

• a) Before moving off bucket is in the correct position

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Keeps vehicles stable during travel - empty or loaded

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Controls the speed of the vehicle appropriate to conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Did not allow vehicle to free wheel

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Did not attempt to turn the vehicle on an incline

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

8. Loading Hoppers

• a) Ensures hopper is ready to receive materials

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Selects and loads the correct materials

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Displays sensitivity of all hydraulic controls

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Controls rate of discharge to avoid damage, blockages & spillage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Maintains stop block & work area

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

9. Loading Dump Trucks

• a) Indicates to receiving vehicle the correct position for loading

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Material loading pattern varied to suit range of receiving vehicles

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Vehicle positioned safely

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Displays sensitivity of all hydraulic controls

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Loads vehicles as required by axle weights or as required by dump truck driver

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Vehicle loaded to avoid spillage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

10. Loading Road Vehicles

• a) Indicates to receiving vehicle the correct position for loading

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Material loading pattern varied to suit range of receiving vehicles

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Vehicle positioned safely

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Displays sensitivity of all hydraulic controls

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Loads vehicles as required by axle weights or as required by wagon driver

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Displays awareness of vehicle sheeting arrangements and avoids damage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Vehicle loaded to avoid spillage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

11. Working at the Face

• Specify Material

  Select Fragmented stone Sand Gravel Waste Coal Other

  • Fragmented stone
  • Sand
  • Gravel
  • Waste
  • Coal
  • Other

• Please Specify Material

• a) Shows awareness of face conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Works across material in sequence

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Removes unwanted / oversized material to designated area for further processing

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Loose materials cleared away

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Approaches material square on with bucket in correct position.

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Follows correct procedure to fill bucket

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Maintains bucket capacity avoiding spillage

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Displays sensitivity of use of hydraulic controls according to working conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• i) Carries out face loading according to site rules / safe system of work

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• j) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

12. Working with Attachments

• Specify Attachment

  Forks

  Jib

  Other

• Please Specify Attachment

• a) Detaches bucket as required by procedures and stores in a safe location

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Attaches attachment as required by procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Checks attachment is securely attached

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Before moving off, attachments are in the correct position

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Selects correct gear in relation to working and environmental conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Observed using correct operating procedures when using attachment

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Detaches attachment as required by procedures and stores in safe location

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Attaches bucket as required by procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• i) Checks bucket is securely attached

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• j) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

13. Parking

• a) Machine on level ground in designated area

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Parked to allow machine to be moved forward following start up

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Bucket in correct position, parking brake applied, in neutral

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Parks vehicle with all round access

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

14. Shut Down

• a) Depletes stored energy

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Engages hydraulic safety control device

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Shuts down to approved/ manufacturers procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Engine off, ignition and isolator key withdrawn

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Secures to instructions and approved procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Drains air tanks ( where applicable )

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

15. Post-Stop Checks

• a) Carries out walk around inspection

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Reports & records damage & faults as required by company & site procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) Refuelling carried out to company & site procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

16. Operational Safety

• a) Operator consistently complies with company & site rules and procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• b) Demonstrates awareness of all obstructions, services and power lines

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• c) All communication in the workplace is clear and concise

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• d) All work activities are carried out to comply with managers instructions/procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• e) Consistently access and egresses the vehicle correctly

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• f) Displays safety awareness at all times - plant / people

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• g) Complies with traffic flows and speed limits ( manager's rules )

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• h) Controls speed to meet changing conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• i) Correct use of gears and accelerator at all times

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• j) Operates vehicle in relation to the weather conditions

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• k) Operates vehicle to minimise effect on the environment

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• l) During travel empty and loaded keeps vehicle stable

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• m) Reports and records faults as required by company procedures

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• n) Does not allow the engine to idle for long periods

  Select Observed Questioned

  • Observed
  • Questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• o) Other

  Select Observed Questioned

  • Observed
  • Questioned

• Please specify what was observed or questioned

• Observation was

  Satisfactory

  Unsatisfactory

• Question was answered

  Satisfactory

  Unsatisfactory

• Assessor's comments on the performance of the operator: (THIS SECTION MUST BE COMPLETED)

• ASSESSOR NAME

• Select date

  Date

• SIGNATURE

  Sign

• ADDITIONAL COMMENTS FROM ASSESSOR

• COMMENTS FROM CANDIDATE (to include any comments regarding the fairness etc of the assessment from the candidate)

• CANDIDATE NAME

• SIGNATURE

  Sign

• Select date

  Date

• LINE MANAGER/SUPERVISOR COMMENTS

• I note the comments made above by the assessor.

• LINE MANAGER NAME

• SIGNATURE

  Sign

• DATE

  Date