Energy Transfer S-270-B Forklift Operator Evaluation

• Site conducted

  Select

• Date

  Date

• Operators Name

• Evaluator's Name

• Check "S" if Satisfactory, "U" if Unsatisfactory

PRE-OPERATIONAL INSPECTION

• 1. Forklift Checklist

  S

  U

• 2. Current forklift driver's certification

  S

  U

PICKING UP LOAD

• 1. Load distribution

  S

  U

• 2. Load stability

  S

  U

• 3. Tine positioning

  S

  U

• 4. Penetration into pallet

  S

  U

• 5. Tilt Lift

  S

  U

• 6. Stopped forklift before load raised/Lowered

  S

  U

• 7. Lowered to safe travel height before moving

  S

  U

• 8. Overhead obstruction check

  S

  U

• 9. Back out slowly, look behind

  S

  U

TRAVELING WITH LOAD

• 1. Look in direction of travel

  S

  U

• 2. Legs/arms inside running lines

  S

  U

• 3. Sound horn at intersections/pedestrians

  S

  U

• 4. Reasonable speed

  S

  U

• 5. Changing directions-stop

  S

  U

• 6. Look before backing

  S

  U

• 7. No Riders

  S

  U

• 8. Ramps and incline

  S

  U

• 9. Braking

  S

  U

• 10. Lift and lower load when traveling

  S

  U

• 11. Distance of tines from floor

  S

  U

• 12. Mount/dismount

  S

  U

LOAD MANIPULATION, STACKING, UNSTACKING

• 1. Forklift centered

  S

  U

• 2. Speed of lift

  S

  U

• 3. Forward movement

  S

  U

• 4. Positioning load on rack

  S

  U

• 5. Back off slow/check for pedestrians

  S

  U

• 6. Fork clear pallet before up/down

  S

  U

SAFETY

• 1. Seatbelt fastened

  S

  U

• 2. Refuel

  S

  U

  NA

• 3. Change fuel bottle

  S

  U

  NA

BATTERY CHARGING

• 1. PPE (Safety Glasses, Gloves)

  S

  U

  NA

• 2. Charger hook-up

  S

  U

  NA

• I certify that the above information is correct and accurate

• Evaluator’s Signature

  Sign

• Operator's Signature

  Sign