Forklift Operator Evaluation

• Conducted on

  Date

• Prepared by

• Location
  Address

Pre-start Safety Knowledge Check

• Conducts pre-shift inspection as per checklist

  Yes

  No

  N/A

• knows rated capacity of truck

  Yes

  No

  N/A

• Uses three points of contact to mount or dismount truck

  Yes

  No

  N/A

Travelling (loaded OR unloaded)

• Wears seat belt

  Yes

  No

  N/A

• Keeps body within operator’s compartment

  Yes

  No

  N/A

• Looks in the direction of travel before and while moving

  Yes

  No

  N/A

• Carries forks high enough off ground to clear obstacles

  Yes

  No

  N/A

• Slows or stops at blind intersections and sounds horn

  Yes

  No

  N/A

• Travels at proper speed based upon circumstances

  Yes

  No

  N/A

• Avoids debris, holes, and uneven ground

  Yes

  No

  N/A

Pedestrian Safety

• Slows, sounds horn, and looks for pedestrians at blind areas

  Yes

  No

  N/A

• Allows no pedestrians near operating forklift

  Yes

  No

  N/A

• Watches for pedestrians in tail swing area

  Yes

  No

  N/A

• Sounds horn before passing pedestrians

  Yes

  No

  N/A

• Allows no pedestrians beneath load

  Yes

  No

  N/A

• Allows no pedestrians to ride on truck or forks

  Yes

  No

  N/A

Load Handling

• Does not handle loads in excess of truck capacity

  Yes

  No

  N/A

• Does not allow loose loads above top of load backrest

  Yes

  No

  N/A

• Does not raise or lower forks while traveling

  Yes

  No

  N/A

• Does not turn with forks elevated

  Yes

  No

  N/A

• Keeps mast vertical (load level) when high stacking

  Yes

  No

  N/A

• Forks properly spaced and positioned to fully engage load

  Yes

  No

  N/A

• Travels in reverse when load obstructs forward visibility

  Yes

  No

  N/A

• Load tilted far enough back to stabilise the load

  Yes

  No

  N/A

Trailer Loading / Unloading

• Tractor turned off and driver exits cab during loading/unloading

  Yes

  No

  N/A

Parking

• Forks lowered

  Yes

  No

  N/A

• Controls neutralised

  Yes

  No

  N/A

• Brakes set

  Yes

  No

  N/A

• Trucks not parked on an incline

  Yes

  No

  N/A

• Engine turned off if operator >25’ from truck

  Yes

  No

  N/A

Notes - Please write any additional notes here:

• Notes:

Signatures

• Driver sign here:

  Sign

• Assessor sign here:

  Sign