Electric Pallet Jack Operator Evaluation Form

• Document No.

• Electric Pallet Jack Operator Evaluation

• Conducted on

  Date

• Operator's name

• Tap to enter information

  Date

• Evaluator/Trainer's name:

I. PRE-OPERATIONAL INSPECTION

• Review electral pallet jack inspection form.

  Yes

  No

  N/A

• Review Oprator's controls.

  Yes

  No

  N/A

II. BASIC OPERATION

• Mount/Dismount.

  Safe

  At Risk

  N/A

• Ability to operate in forward/reverse directions.

  Yes

  No

  N/A

• Ability to steer/turn.

  Yes

  No

  N/A

• Operator faces direction of travel.

  Yes

  No

  N/A

• Operator sounds horn at Intersections/Doorways/Corners.

  Yes

  No

  N/A

III. PICKING UP A LOAD/DROPPING A LOAD

• Electric pallet jack is centered under the load.

  Yes

  No

  N/A

• Operator stopped before raising/lowering load.

  Yes

  No

  N/A

• Load is stable on electric pallet jack.

  Yes

  No

  N/A

• Operator looks behind before backing out slowly.

  Yes

  No

  N/A

• I certify that the information is correct and accurate. Evaluator/Trainer's signature.

  Sign