CPCC Forklift Operator Evaluation - condensed version

• Document No.

• Harper Campus

• Conducted on

  Date

• Operator is being evaluated to operate a forklift because it is a requirement of their job description or function?

  Select Yes, proceed with operator evaluation No, contact ehs@cpcc.edu for approval

  • Yes, proceed with operator evaluation
  • No, contact ehs@cpcc.edu for approval

Forklift

• Type of equipment?

  Select Hyundai Toyota Unicarriers

  • Hyundai
  • Toyota
  • Unicarriers

Daily Safety Inspection

• Operator fully understands the capacity information plate?

  Yes

  No

  N/A

• Operator knows where the propane is stored and correct procedures for refueling?

  Yes

  No

  N/A

• Operator understands the correct reporting procedures for a forklift that needs to be taken out of service?

  Yes

  No

  N/A

Operator Safety & Observation

• Operator mounts / dismounts correctly?

  Yes

  No

  N/A

• Operator uses the seatbelt correctly?

  Yes

  No

  N/A

• Operator keeps body parts within the confines of the vehicle?

  Yes

  No

  N/A

• Operator looks in the direction of travel?

  Yes

  No

  N/A

• Operator practices correct use of the horn when appropriate?

  Yes

  No

  N/A

• Operator watches for pedestrians and yields right of way?

  Yes

  No

  N/A

• Operator follows the correct procedures for an "unattended" vehicle?

  Yes

  No

  N/A

Steering & Operating Controls

• Operator starts and stops smoothly?

  Safe

  At Risk

  N/A

• Operator does not brake harshly / erratically?

  Safe

  At Risk

  N/A

• Operator does not raise or lower the load and forks when the lift truck is in motion?

  Safe

  At Risk

  N/A

• Operator safely operates equipment 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

• Operator keeps forks 6 inches above the work surface when traveling?

  Yes

  No

  N/A

• Operator performs safe maneuvering with the lift truck and load?

  Yes

  No

  N/A

• Operator travels with the load facing uphill while on a ramp or incline?

  Yes

  No

  N/A

• Operator follows other vehicles at a safe distance?

  Yes

  No

  N/A

• Operator slows down when cornering?

  Yes

  No

  N/A

Stacking & de-stacking

• Operator squared up to the location; then stopped about 1 foot away?

  Safe

  At Risk

  N/A

• Operator had fork arms centered correctly to support the load?

  Safe

  At Risk

  N/A

• Operator raised load to placement level?

  Safe

  At Risk

  N/A

• Operator had forks positioned to not touch the stack / load?

  Safe

  At Risk

  N/A

• Operator had the forks/ load level?

  Safe

  At Risk

  N/A

• Operator had the load correctly stacked?

  Safe

  At Risk

  N/A

• Operator had the fork arms fully inserted?

  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.

• Operator backed straight out until the forks cleared?

  Safe

  At Risk

  N/A

Parking

• Operator correctly applies the parking brake?

  Safe

  At Risk

  N/A

• Operator sets the direction lever to the neutral position?

  Safe

  At Risk

  N/A

• Operator correctly applies forward tilt?

  Safe

  At Risk

  N/A

Operator Evaluation & Assessment Recommendations

• Based upon the assessor's evaluation:

  Select Operator has successfully completed the forklift operator evaluation and is qualified to operate the forklift. Operator has not demonstrated competence during the forklift operator evaluation and is not qualified to operate the forklift.

  • Operator has successfully completed the forklift operator evaluation and is qualified to operate the forklift.
  • Operator has not demonstrated competence during the forklift operator evaluation and is not qualified to operate the forklift.

• Comments

Signatures

• Date and time of assessment

  Date

• Operator signature

  Sign

• Assessor signature

  Sign