Title Page

  • Boom Lift Operator Evaluation

  • Jobsite Location:
  • Job #

  • Manufacturer (s)

  • Model (s)

  • Date of Verification:

  • Weather - Select all that apply

  • Superintendent (s):

  • Operator Name:

  • Years of Expierience

  • Reason for Evaluation

  • Evaluated By

Evaluation

BEFORE STARTING ENGINE

  • Daily Pre-Use Inspection Completed?

  • Perform assessment walk of work area, check of area of operation and surrounding work area for potential hazards

FALL PROTECTION VERIFICATION

  • Demonstrate proper inspection of harness & lanyard

  • Hand rails are fall protection on scissor lifts unless feet leave floor of working platform.

  • Harness & lanyard required immediately upon entering working platform on boom lifts.

  • Anchorage points (structural w/scissor lift, manufacturer’s provided anchorage on boom lifts)

START UP & MANEUVERING

  • Control panel – legible, ensure operation functions are understood

  • Backup alarm – verify operational if equipped

  • Test brake or traction system (to make sure it will hold)

  • Operator turns body and head in direction of travel for best visibility.

  • Looking around for surface problems, avoid those problems

  • Adjust speed to conditions of work area

  • Raise and lower platform

  • Extend and retract platform

  • Traverse Left and Right

  • Turn unit slowly and at a proper speed for conditions

  • Maneuver around obstacles – similar to those that will be encountered in the work area.

  • Arms and legs are kept inside operations compartment at all times

PARKING

  • Engine or electrical stop switch is in the off position

  • Assure machine is lowered all the way and is stopped on as level surface as possible

  • Maintains three points of contact when dismounting. Does not jump off of machine.

  • Building or area access/egress is not blocked.

EVALUATION

  • Based on my evaluation, the operator has completed the evaluation and is qualified to operate the equipment

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.