B Safe Forklift Operator Training

• Course Title

• Course Number

• Customer

• Operator Name

• Start Date and Course Introduction

  Date
• Location
  Address

Assessor/Instructor Competancy

• The assessor/Instructor must be trained as per PUWER Regulation 9 Section 2.2 and have a full understanding of all plant vehicle operation that they are to assess.

• Instructor Name

Operator Details

• Date of Birth

• Photo of operator

  Media

• Health Operator is fit and in good health to be able to operate machinery at work including good vision with or without visual aid

• Select Yes No

  • Yes
  • No

• If an operator has no proof of training held on record, they must not operate a forklift truck until proof of training Competancy has been proven?

• Date of last test/Assessment or training course

  Date

• Does the candidate have a certificate of training that has been passed or refreshed within the last three years?

  yes

  no

• Does the candidate have a certificate of training that has been passed or refreshed within the last three years?

  yes

  no

• If no training or assessment, how much experience has operator had.

  1-6 m

  6-12 m

  1-3 years

  over 3 years

• Operated truck on a regular basis within the last 12 months

  yes

  no

• Declaration date of above details

  Date

• Declaration of details above

  Sign

Plant Vehicle

• Type of plant equipment?

  Select Counterbalance Reach Pivot Steer

  • Counterbalance
  • Reach
  • Pivot Steer

Truck information

• Make/Model

• Load capacity

• Mast height

• Load Centre

  Select 500mm 600mm

  • 500mm
  • 600mm

• Attachments

  Forks

  Clamps

  Boom

Course Record

• Course Introduction

• Select date

  Date

• HSAWA 1974

  Yes

  No

  N/A

• Select date

  Date

• Safety Films

  Safety Essentials

  Reach

  Pivot Steer

• Select date

  Date

• Intro to truck

• Select date

  Date

• Elementary Driving

  Yes

  No

  N/A

• Select date

  Date

• Steering Exercises - Open Areas

  Yes

  No

  N/A

• Select date

  Date

• Steering Exercises - Confined Areas

  Yes

  No

  N/A

• Lessons in picking up loads Depends on operator experience/needs

• Racking System used

  Select Yes No

  • Yes
  • No

• Select date

  Date

• Demonstration of a Pre shift check by Instructor

• Select date

  Date

• Demonstration of Code of practice

• Select Yes No

  • Yes
  • No

• Select date

  Date

• Film - Stability

• Select date

  Date

• Practical Assessment

• Select date

  Date

Daily Safety Inspection

• The operator completes the Pre-shift inspection on the machine

  Yes

  No

  N/A

• Select date

  Date

• The operator fully understands the capacity information plate?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• If a fault has been found, the lift truck must be parked up in a safe place and the key removed. The fault must be made to a member of the management team.

Theory Questions

• Operated truck operator passed the theory assessment

  yes

  no

• Photo of completed theory question sheet

  Media

• Select date

  Date

Operator Assessment

• Operated truck forward and in reverse, laden and unladen

  Safe

  At Risk

  N/A

• Operated truck forward and in reverse, laden and unladen

  Safe

  At Risk

  N/A

• Correct travel position of the forks/attachment when travelling unladen?

  Safe

  At Risk

  N/A

• Executed 90 degree turns, left and right in a working aisle to suit the truck

  Safe

  At Risk

  N/A

• Correct use of the horn when appropriate?

  Safe

  At Risk

  N/A

• Bulk stacked and de-stacked loads

  Safe

  At Risk

  N/A

• Select Floor Eye level High level

  • Floor
  • Eye level
  • High level

• Stacked and de-stacked in Pallet racking

  Safe

  At Risk

  N/A

• Select Floor Eye level High level

  • Floor
  • Eye level
  • High level

• Operator had good all round safety observation?

  Safe

  At Risk

  N/A

• Loaded/unloaded company/delivery vehicle with loads

  Safe

  At Risk

  N/A

• The operator correctly parks the truck in a safe area and removes key

  Safe

  At Risk

  N/A

Assessment Recommendations & Evaluations

• Assessors evaluation of operator safety?

  Select Excellent Good Satisfactory Re-training is advised

  • Excellent
  • Good
  • Satisfactory
  • Re-training is advised

• Comments

• Course Pass with an evaluation of Excellent / Good / Satisfactory

Signatures

• Date of assessment

  Date

• Operator signature

  Sign

• Assessor signature

  Sign