Title Page

  • Operator Name:

  • Evaluator Name:

  • Client:

  • Conducted on

  • Authorized Equipment:


  • Does the company perform inspections each shift the forklift is used? Does the operator know where the inspection form is located?


  • 3 points of control facing the forklift?

  • Seat belt used?

  • Disengage parking break?

Picking up & Placing Load

  • Square up on center of the load:

  • Make sure there is sufficient clearance for the load:

  • Stop with the forks tips about 1 foot from the load:

  • Clears personal from the area near the load:

  • Levels the forks; then slowly approaches the load until the load contacts the carriage:

  • Lifts the load carefully and smoothly until it is clear:

  • Tilts the mast back slightly to stabilize the load:

  • Looks over both shoulders before lowering the load:

  • After out and stopped, lowers the load to traveling height:

  • Raise the load to placement level:

  • Lower forks to traveling position:

Traveling with load

  • Does not raise or lower the forks while traveling, if needed stops before raising or lowering then continues traveling:

  • Maintains safe speed:

  • Observes all traffic rules, warning signs, floor load limits, and overhead clearances:

  • Keeps arms, hands, legs, and feet inside the roll over cage at all times:

  • Follows other vehicles at safe distance:

  • Slows down when cornering:

  • Uses horn to alert others:

  • Travels with load facing uphill while on a ramp or incline:

  • Stops smoothly:


  • Fully lower forks:

  • Neutralizes controls:

  • Sets the brakes:

  • Turn off power:

  • If parked on incline, block the wheels:

  • Park only in authorized areas:

Fueling And or Battery Recharging

  • Engine off:

  • Fire extinguisher nearby:

  • Proper personal protective equipment, have them list what they would wear for refueling, adding water, recharging, etc :

  • Spills cleaned up immediately: How would they clean up a spill?

  • Ensure following safe fueling and recharging procedures:

Evaluation Assessment

  • Based on my evaluation the operator has successfully completed the evaluation and is qualified to operate the equipment listed I. The authorized equipment section above.

  • Operators Signature

  • Evaluators Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.