Title Page
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Boom Lift Operator Evaluation
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Jobsite:
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Date of Evaluation:
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Make and Model: (take photo of machine)
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Superintendent (s):
- Agustin Gonzalez
- Agustin Soto Moreno
- Carmen Diaz
- Cirino Romero
- Daniel Gato
- Eddie Gonzales
- Emmanuel Ramirez
- Esteban Romero
- Ever Osorto
- Freddy Ortega
- Gaudy Gonzalez
- Jose Maldonado
- Max Olvera
- Pancho Juan Remedios
- Phil Stephens
- Rene Ortega
- Roger Wikowsky
- Salvador Hernandez
- Sebastian Rubio
- Victor Ortega
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Operator Name:
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Years of Experience:
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Reason for Evaluation:
- Renewal Training (3 Year)
- Initial training with Universal Forming
- The operator is assigned to drive a different type of equipment
- The operator has been involved in an accident or near-miss incident
- The operator has been observed to operated vehicle in unsafe manner
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Evaluated By:
Evaluation
BEGINNING LIFT OPERATION
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Completes Operator’s Daily Checklist, before operating
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Personal Fall Arrest system is secured before operating lift.
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Operator is wearing the appropriate safety equipment.
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Checks that batteries are fully charged or that the fuel tank is full
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Demonstrate proper inspection of harness & lanyard
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Harness & lanyard required immediately upon entering working platform on boom lifts.
SKILLS PROFICIENCY
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Drives forward and reverse from creep to full speed in both high and low drive range (operate steer left and right during drive sequence
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Perform gradual stop by slowly returning drive joystick controller to center position
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Perform quick stop by releasing drive joystick controller to center position
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Perform an emergency stop by driving, then releasing function enable switch-footswitch (booms) or joystick switch (scissors)
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Raise the platform off the speed limit switch and operate drive forward and reverse
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Operate the platform up function(s) and boom extend functions (when applicable) until platform is at full height
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Return all functions to the fully stowed position
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Turn off machine with the emergency stop button
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Visually scans the surrounding area, and uses the vehicles mirrors and/or fixed mirrors at the work site.
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Watch for debris or surface irregularities in the direction of travel
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Maintains a clear view in the direction of travel
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Slows down and looks before turning into an aisle or intersection.
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Arms and legs are kept inside operations compartment at all times
PEDESTRIAN TRAFFIC
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Decreases speed when approaching a pedestrian.
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Yields right of way to all pedestrians.
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Sounds horn to alert pedestrians.
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Gets pedestrians’ attention before passing.
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Maintains vision in the direction of travel and proceeds slowly.
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Always tries to keep a clear view of his path of direction.
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Observes all site-specific traffic rules and speed limits.
PARKING
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Engine or electrical stop switch is in the off position
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Assure machine is lowered all the way and is stopped on as level surface as possible
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Maintains three points of contact when dismounting. Does not jump off of machine.
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Building or area access/egress is not blocked.
EVALUATION
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Based on my evaluation, the operator has completed the evaluation and is qualified to operate the equipment