CPCC Forklift Operator Evaluation

• Forklift Training Evaluation Checklist

• Document No.

• Location

• Conducted on

  Date

• Operator

• Assessor

Forklift

• Type of equipment?

  Select Hyundai Toyota Unicarriers

  • Hyundai
  • Toyota
  • Unicarriers

Operator Details

• The operator has completed training in Percipio.

Daily Safety Inspection

• Operator completes the pre-use safety inspection correctly?

  Yes

  No

  N/A

• 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

• Operator performed and adhered to overall safety procedures well during observation?

  Yes

  No

  N/A

Steering & Operating Controls

• Operator starts and stops smoothly?

  Safe

  At Risk

  N/A

• Operator avoids travelling unintentionally in the wrong direction?

  Safe

  At Risk

  N/A

• Operator does not brake harshly / erratically?

  Safe

  At Risk

  N/A

• Operator releases the parking brake prior to moving the forklift?

  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 avoids rough use of hydraulic controls?

  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 looks in the direction of travel while driving in reverse?

  Yes

  No

  N/A

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

  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 uses the horn to alert others?

  Yes

  No

  N/A

• Operator slows down when cornering?

  Yes

  No

  N/A

Stacking & de-stacking

• Operator ensures there is sufficient clearance for the load?

  Safe

  At Risk

  N/A

• 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 fork arms positioned to not rub (entry / withdrawal)?

  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 looked over both shoulders before backing out?

  Safe

  At Risk

  N/A

• Operator backed straight out until the forks have cleared?

  Safe

  At Risk

  N/A

• Operator lowered the forks to traveling position?

  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 correctly lowers the forks?

  Safe

  At Risk

  N/A

• Operator maneuvered wheels in a straight position?

  Safe

  At Risk

  N/A

• Operator parks in a safe location, not blocking doors or emergency equipment?

  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