Br23 Forklift Truck Operator Safety Evaluation Form - duplicate - duplicate

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Assessor Competancy

• The assessor must be trained and have a full understanding of all plant vehicle operation that they are to assess. If you require further information, contact Aaron Turner.

Plant Vehicle

• Type of plant equipment?

  Select LPG Forklift Narrow Aisle Reach Truck Powered Pallet Truck Scissor Lift LPG Sweeper Electric Walk Behind Die Cart Electric Walk Behind Forklift Electric Walk Behind Pallet Truck Electric Golf Cart Push-Pull Hand Jack Manual Walk Behind Pallet Tipper Electric Walk Behind Battery Puller

  • LPG Forklift
  • Narrow Aisle Reach Truck
  • Powered Pallet Truck
  • Scissor Lift
  • LPG Sweeper
  • Electric Walk Behind Die Cart
  • Electric Walk Behind Forklift
  • Electric Walk Behind Pallet Truck
  • Electric Golf Cart
  • Push-Pull Hand Jack
  • Manual Walk Behind Pallet Tipper
  • Electric Walk Behind Battery Puller

Operator Details

• Date of test or refresher course?

  Date

• Date of signed authorization to operate the plant vehicle?

  Date

Daily Safety Inspection

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• 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.

Operator Safety & Observation

• The operator mounts / dismounts correctly?

  Yes

  No

  N/A

• Uses the seatbelt correctly?

  Yes

  No

  N/A

• Keeps body parts within the confines of the vehicle?

  Yes

  No

  N/A

• Operator looks in the direction of travel?

  Yes

  No

  N/A

• Correct use of the horn when appropriate?

  Safe

  At Risk

  N/A

• Follows the correct procedures for an "unattended" vehicle?

  Yes

  No

  N/A

• Operator had good all round safety observation?

  Yes

  No

  N/A

Steering & Operating Controls

• Starts and stops smoothly?

  Yes

  No

  N/A

• Correct use of the steering assistor?

  Yes

  No

  N/A

• Travels unintentionally in the wrong direction?

  Safe

  At Risk

  N/A

• Brakes harshly / erratically?

  Safe

  At Risk

  N/A

• Releases the parking brake prior to moving off?

  Yes

  No

  N/A

• Operator rides the foot brake?

  Safe

  At Risk

  N/A

• Operates the hydraulic controls when the lift truck is in motion?

  Safe

  At Risk

  N/A

• Rough use of hydraulic controls?

  Safe

  At Risk

  N/A

• Operates and understands the controls?

  Safe

  At Risk

  N/A

Competency In Load Capacity

• Operator matches load with the trucks capacity?

  Yes

  No

  N/A

• Operator checks the load for stability?

  Yes

  No

  N/A

Maneuvering & Transportation

• Forks to high when traveling?

  Yes

  No

  N/A

• Forks to low when traveling?

  Yes

  No

  N/A

• Operating in reverse, looking in the direction of travel to the correct ratio?

  Safe

  At Risk

  N/A

• Operates at a speed consistent with the type of load and working conditions?

  Safe

  At Risk

  N/A

• Operator performs safe manoeuvring with the lift truck and load!

  Yes

  No

  N/A

Stacking & de-stacking

• Incorrect set down at a vertical face?

  Safe

  At Risk

  N/A

• Operator applies the park brake when operating the hydraulics?

  Safe

  At Risk

  N/A

• Operator applies neutral when operating the hydraulics?

  Safe

  At Risk

  N/A

• Fork arms central under the load?

  Safe

  At Risk

  N/A

• Fork arms not rubbing (entry / withdrawal)?

  Safe

  At Risk

  N/A

• Fork tips touch the stack / load?

  Safe

  At Risk

  N/A

• Forks / load not level?

  Safe

  At Risk

  N/A

• Load correctly stacked?

  Safe

  At Risk

  N/A

• Fork arms not fully inserted (undercut) ?

  Safe

  At Risk

  N/A

• It is some times necessary to undercut a load due to the nature of where it is to be located. It must remain within the limits of the capacity plate.

Parking

• The operator correctly applies the park brake?

  Safe

  At Risk

  N/A

• The operator sets the direction lever to the neutral position?

  Safe

  At Risk

  N/A

• The operator correctly apples forward tilt?

  Safe

  At Risk

  N/A

• The operator correctly lowers the fork arms?

  Safe

  At Risk

  N/A

• The manoeuvring wheels are in the straight position?

  Safe

  At Risk

  N/A

• The operator switches off and removes the key?

  Safe

  At Risk

  N/A

Assessment Recommendations & Evaluations

• Assessors evaluation of operator safety?

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Comments

Signatures

• Date and time of assessment

  Date

• Operator signature

  Sign

• Assessor signature

  Sign