Forklift Operator Safety Evaluation Form

• Document No.

• Forklift Operators Safety Evaluation

• Conducted on

  Date

• Operators name

• Tap to enter information

  Date

• Evaluator/Trainer's name:

I. PRE-OPERATIONAL INSPECTION

• Review the Forklift safety check list.

  Yes

  No

  N/A

• Review Operator's controls.

  Yes

  No

  N/A

• Review Refueling/Recharging procedures.

  Yes

  No

  N/A

II. BASIC OPERATION

• Mount/Dismount Forklift.

  Safe

  At-Risk

  N/A

• Arms and legs are inside the cage.

  Yes

  No

  N/A

• Operator wears seatbelt.

  Yes

  No

  N/A

• Ability to drive in Forward/Reverse direction.

  Yes

  No

  N/A

• Ability to Steer/Turn the Forklift.

  Yes

  No

  N/A

• Operator sounds the horn at Intersections/Doorways/Corners.

  Yes

  No

  N/A

III. PICKING UP A LOAD/UNSTACKING

• Operator checks for overhead obstructions.

  Yes

  No

  N/A

• Forklift is centered to the load.

  Yes

  No

  N/A

• Operator stops before raising/lowering forks.

  Yes

  No

  N/A

• Forks fully penetrate into the load.

  Yes

  No

  N/A

• Tilt/Lift the load

  Yes

  No

  N/A

• Is the load stable on the forks.

  Yes

  No

  N/A

• Operator looks behind when backing out slowly.

  Yes

  No

  N/A

IV. TRAVELING WITH A LOAD

• Operator looks in the direction of travel.

  Yes

  No

  N/A

• Operator travels at a resonable speed.

  Yes

  No

  N/A

• Operator sounds the horn at Intersections/Doorways/Corners

  Yes

  No

  N/A

• Operator looks behind before backing.

  Yes

  No

  N/A

• Operator traveling up Ramps/Incline.

  Safe

  At-Risk

  N/A

• Breaking with a load.

  Safe

  At-Risk

  N/A

• Lift/Lower load while traveling.

  No

  Yes

  N/A

• Hight of forks from floor (2-4 inches)

  Yes

  No

  N/A

• Double loads/awkward loads.

  Safe

  At-Risk

  N/A

V. STACKING LOADS

• Forward movement

  Safe

  At-Risk

  N/A

• Position of load on Stack/Rack.

  Safe

  At-Risk

  N/A

• Operator looks behind before backing.

  Yes

  No

  N/A

• Forks clears the load before Lifting/Lowering.

  Yes

  No

  N/A

VI. TRUCK LOADING/UNLOADING

• Truck/Trailer is chalked.

  Yes

  No

  N/A

• Breaks on truck/trailer are set.

  Yes

  No

  N/A

• Dock boards/Bridge plates are in place.

  Yes

  No

  N/A

• Travel up ramp in forward direction with load.

  Yes

  No

  N/A

• Travel down ramp in backwards direction with load.

  Yes

  No

  N/A

• I certify that the information is correct and accurate . Evaluator/Trainers signature.

  Sign