Forklift Operator Evaluation Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

undefined

• Yes

  No

  N/A

undefined

• Yes

  No

  N/A

• Yes

  No

  N/A
• Location
  Address

• Personnel

• Good

  Fair

  Poor

  N/A

• 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

  initial

  refresher

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

  Date

Operator's Behavior

• Pre-use Inspection

• Follows the operator's daily checklist

  Good

  Fair

  Poor

  N/A

• Look for damage

  Good

  Fair

  Poor

  N/A

• Documents all findings on the checklist

  Good

  Fair

  Poor

  N/A

• Picking Up a Load

• Squares up on the center of the load

  Good

  Fair

  Poor

  N/A

• Stop with the fork tips about 1 foot from the load

  Good

  Fair

  Poor

  N/A

• Clear personnel from the area near the load

  Good

  Fair

  Poor

  N/A

• Level the forks; then slowly drive forward until the load contacts the carriage

  Good

  Fair

  Poor

  N/A

• Lift the load carefully and smoothly until it is clear

  Good

  Fair

  Poor

  N/A

• Tilt the mast back slightly to stabilize the load

  Select Good Fair Poor N/A

  • Good
  • Fair
  • Poor
  • N/A

• Look over both shoulders

  Good

  Fair

  Poor

  N/A

• After out and stopped, lower the load to travel height

  Good

  Fair

  Poor

  N/A

• Traveling

• Do not raise or lower the load and forks while traveling

  Good

  Fair

  Poor

  N/A

• Maintain a safe speed

  Good

  Fair

  Poor

  N/A

• Observe all traffic rules, warning signs, floor load limits, and overhead clearance

  Good

  Fair

  Poor

  N/A

• Keep arms and legs inside the forklift

  Good

  Fair

  Poor

  N/A

• Follow other vehicles at a safe distance

  Good

  Fair

  Poor

  N/A

• Slow down when turning the corner

  Good

  Fair

  Poor

  N/A

• Use the horn to alert others.

  Good

  Fair

  Poor

  N/A

• Travel with the load facing uphill while on a ramp or incline

  Good

  Fair

  Poor

  N/A

• Putting Down A Load

• Make sure there is sufficient clearance for the load

  Good

  Fair

  Poor

  N/A

• Clear personnel for the area near the load

  Good

  Fair

  Poor

  N/A

• Square up to the location; then stop about 1 foot away

  Good

  Fair

  Poor

  N/A

• Raise the load to placement level

  Good

  Fair

  Poor

  N/A

• Move slowly forward

  Good

  Fair

  Poor

  N/A

• If the load is on a pallet, lower it into position and lower the forks further

  Good

  Fair

  Poor

  N/A

• Look over both shoulders before backing out

  Good

  Fair

  Poor

  N/A

• Back straight out until the forks have cleared

  Good

  Fair

  Poor

  N/A

• Lower the forks to traveling position

  Good

  Fair

  Poor

  N/A

• Parking

• Fully lower the forks

  Good

  Fair

  Poor

  N/A

• Neutralize the controls

  Good

  Fair

  Poor

  N/A

• Set the brakes

  Good

  Fair

  Poor

  N/A

• Turn off the power

  Good

  Fair

  Poor

  N/A

• If parked on an incline, block the wheels

  Good

  Fair

  Poor

  N/A

• Park only in authorized areas

  Good

  Fair

  Poor

  N/A

• Fueling and Battery Recharging

• Turn the engine off

  Good

  Fair

  Poor

  N/A

• Keep a fire extinguisher nearby

  Good

  Fair

  Poor

  N/A

• Use the proper PPE

  Good

  Fair

  Poor

  N/A

• Follow safe fueling and battery recharging procedures

FINAL EVALUATION

• Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the following equipment:

• Based on my evaluation, the operator has not demonstrated competence operating power industrial trucks

• Operator Signature

  Sign

• Evaluator Signature

  Sign