Forklift Operator Evaluation Form - rev1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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

  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

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

Equipment Operated

• Make and Model#

• Select date

  Date

Pre-Use inspection

• Mast, Mastguard and Forks

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Wheels and Tires

  Good

  Fair

  Poor

  N/A

• Engine Fluid Levels

  Good

  Fair

  Poor

  N/A

• Fan Belts

  Good

  Fair

  Poor

  N/A

• Engine Cover Latches (secured)

  Good

  Fair

  Poor

  N/A

• Rollover Protection (secured)

  Good

  Fair

  Poor

  N/A

• Seatbelt

  Good

  Fair

  Poor

  N/A

• Backup Alarm

  Good

  Fair

  Poor

  N/A

• Controls

  Good

  Fair

  Poor

  N/A

• Labels, Markings and Load Chart

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Inspection

• Braking

  Good

  Fair

  Poor

  N/A

• Propane Connections

  Good

  Fair

  Poor

  N/A

• Mounting Brackets

  Good

  Fair

  Poor

  N/A

• General Check For Leaks

  Good

  Fair

  Poor

  N/A

Travel

• Kept Forks Low

  Good

  Fair

  Poor

  N/A

• Continued to Wear Seatbelt

  Good

  Fair

  Poor

  N/A

• Maintained Reasonable Speed

  Good

  Fair

  Poor

  N/A

• Yielded to Pedestrians

  Good

  Fair

  Poor

  N/A

• Used Horn Appropriately

  Good

  Fair

  Poor

  N/A

• Forks Kept Up-Ramp (Loaded)

  Good

  Fair

  Poor

  N/A

• Avoided Running Over Objects

  Good

  Fair

  Poor

  N/A

• Recognized Over-Head Hazards

  Good

  Fair

  Poor

  N/A

Positioning Load

• Load Within Capacity

  Good

  Fair

  Poor

  N/A

• Load Balanced

  Good

  Fair

  Poor

  N/A

• Load Secure

  Good

  Fair

  Poor

  N/A

• COG Positioned Properly

  Good

  Fair

  Poor

  N/A

• Tilted Load Back

  Good

  Fair

  Poor

  N/A

• Used Guide/Drove Backwards

  Good

  Fair

  Poor

  N/A

High Stacking

• Rack Capacity/Stacking Limits

  Good

  Fair

  Poor

  N/A

• Lowered Load/Withdrew

  Good

  Fair

  Poor

  N/A

• Elevated Load Close To Rack

  Good

  Fair

  Poor

  N/A

• Load Tilted Rearwards During Lift

  Good

  Fair

  Poor

  N/A

• Load Tilted Forwards Over Rack

  Good

  Fair

  Poor

  N/A

Shutdown

• Forks Lowered To The Floor

  Good

  Fair

  Poor

  N/A

• Parking Brake Engaged

  Good

  Fair

  Poor

  N/A

• Shifted Into Neutral

  Good

  Fair

  Poor

  N/A

• Turned Engine Off

  Good

  Fair

  Poor

  N/A

• 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.

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