FLT EVALUATION

• Site conducted

  Select

• Department

• Conducted on

  Date

• Prepared by

• NAME OF OPERATOR

• NAME OF EVALUATOR

• DATE

  Date

• TYPE OF FLT AND FLEET NUMBER

PRE OPERATION OF THE FLT

• WAS A PRE USE INSPECTION CARRIED OUT

  Yes

  No

  N/A

• WAS A VISUAL INSPECTION OF THE WORK AREA CARRIED OUT

  Yes

  No

  N/A

• WAS A VISUAL INSPECTION OF THE LOAD CARRIED OUT

  Yes

  No

  N/A

• WERE THE FORKS ADJUSTED FOR THE LOAD

  Yes

  No

  N/A

• WAS THE WEIGHT OF THE LOAD PRE- DETERMINED BEFORE OPERATIONS COMMENCED

  Yes

  No

  N/A

• WAS THE FLOOR OF THE TRAILER/ VEHICLE INSPECTED BEFORE OPERATIONS COMMENCED

  Yes

  No

  N/A

• WERE THE TRAILER/ VEHICLE BRAKES AFFIXED AND VEHICLE ENGINE SWITCHED OFF

  Yes

  No

  N/A

• ARE THE VEHICLE KEYS REMOVED FROM THE VEHICLE BEING LOADED

  Yes

  No

  N/A

• DID THE OPERATOR USE THE SEAT BELT

  Yes

  No

  N/A

OPERATION OF THE FLT

• DID THE OPERATOR SHOW FAMILARITY WITH THE CONTROLS

  Yes

  No

  N/A

• WAS THE LOAD APPROACHED AT A SAFE SPEED

  Yes

  No

  N/A

• DID THE OPERATOR POSITION THE FORKS AND FLT CORRECTLY WITHOUT HITTING ANYTHING

  Yes

  No

  N/A

• WERE THE FORKS POSITIONED UNDER THE LOAD CORRECTLY

  Yes

  No

  N/A

• WAS THE LOAD CORRECTLY BALANCED

  Yes

  No

  N/A

• DID THE OPERATOR RAISE AND TILT THE LOAD PROPERLY

  Yes

  No

  N/A

• WAS THE LOAD RAISED OR LOWERED TO 6 INCHES FROM THE GROUND PRIOR TO TRAVELLING

  Yes

  No

  N/A

• DID THE OPERATOR MOVE AT A SAFE SPEED WITH THE LOAD

  Yes

  No

  N/A

• DID THE OPERATOR HAVE GOOD ALL ROUND UNOBSTRUCTED VISION

  Yes

  No

  N/A

• DID THE OPERATOR TRAVEL IN REVERSE WHEN THE VIEW WAS OBSTRUCTED

  Yes

  No

  N/A

• DID THE OPERATOR SOUND THEIR HORN WHEN ENTERING OR EXITING WAREHOUSES

  Yes

  No

  N/A

• DID THE OPERATOR SOUND THEIR HORN AT INTERSECTIONS

  Yes

  No

  N/A

• DID THE OPERATOR SOUND THEIR HORN WHEN ENTERING OR EXITING AISLES

  Yes

  No

  N/A

• DID THE OPERATOR TURN CORNERS SAFELY

  Yes

  No

  N/A

• DID THE OPERATOR DRIVE UP AND DOWN INCLINES SAFELY

  Yes

  No

  N/A

• DID THE OPERATOR LOOK BEHIND BEFORE REVERSING

  Yes

  No

  N/A

• DID THE OPERATOR MAINTAIN A MINIMUM OF 1 METRE DISTANCE FROM ALL PERSONNEL WHILST OPERATING

  Yes

  No

  N/A

• DID THE OPERATOR STOP THE FLT IN A SMOOTH MANNER

  Yes

  No

  N/A

• WAS THE FLT PARKED IN A SAFE AREA

  Yes

  No

  N/A

POST OPERATION OF THE FLT

• WERE THE FORKS PLACED ON THE GROUND

  Yes

  No

  N/A

• WERE THE CONTROLS PLACED INTO NEUTRAL

  Yes

  No

  N/A

• WAS THE PARKING BRAKE APPLIED

  Yes

  No

  N/A

• WAS THE FLT CLOSED DOWN TO PREVENT UNAUTHOURISED USE

  Yes

  No

  N/A

• WHAT WAS THE LEVEL OF COMPETENCE DISPLAYED BY THE FLT OPERATOR

  Safe

  At Risk

  N/A

• RESULT OF THE OVERALL EVALUATION

  Pass

  Fail

  N/A

• WORDS OF ADVICE GIVEN TO THE FLT OPERATOR

• DOES THE FLT OPERATOR AGREE TO; AND WILL ADHERE TO THE WORDS OF ADVICE GIVEN

  Yes

  No

  N/A

• OTHER COMMENTS

• LIST ANY CONTROL MEASURES THAT NEED IMPLEMENTING

• TIMEFRAME FOR IMPLEMENTATION OF ANY ADDITIONAL CONTROL MEASURES

  IMMEDIATE

  WITHIN 3 MONTHS

  WITHIN 6 MONTHS

• SIGNATURE OF OPERATOR

  Sign

• SIGNATURE OF EVALUATOR

  Sign