Title Page
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
Instructions- use the checklist during field sessions to evaluate operator proficiency. It can also be used for periodic evaluation to ensure that operators are continuing to operate forklifts properly.
-
Training
Current Forklift Traing Card
-
Original Forklift Model#
-
Original Date Certified
-
Operator Name
-
Evaluator Name
-
Date of Evaluation
-
Location
Equipment Operated
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
-
Make and Model#
-
Select date
Pre-Use inspection
-
Mast, Mastguard and Forks
-
Wheels and Tires
-
Engine Fluid Levels
-
Fan Belts
-
Engine Cover Latches (secured)
-
Rollover Protection (secured)
-
Seatbelt
-
Backup Alarm
-
Controls
-
Labels, Markings and Load Chart
-
Steering
Inspection
-
Braking
-
Propane Connections
-
Mounting Brackets
-
General Check For Leaks
Travel
-
Kept Forks Low
-
Continued to Wear Seatbelt
-
Maintained Reasonable Speed
-
Yielded to Pedestrians
-
Used Horn Appropriately
-
Forks Kept Up-Ramp (Loaded)
-
Avoided Running Over Objects
-
Recognized Over-Head Hazards
Positioning Load
-
Load Within Capacity
-
Load Balanced
-
Load Secure
-
COG Positioned Properly
-
Tilted Load Back
-
Used Guide/Drove Backwards
High Stacking
-
Rack Capacity/Stacking Limits
-
Lowered Load/Withdrew
-
Elevated Load Close To Rack
-
Load Tilted Rearwards During Lift
-
Load Tilted Forwards Over Rack
Shutdown
-
Forks Lowered To The Floor
-
Parking Brake Engaged
-
Shifted Into Neutral
-
Turned Engine Off
-
I hereby certify that I have conducted an evaluation of this employee's ability to safely operate the lift truck models listed above and I have determined their performance is satisfactory.
-
Add signature