Forklift Truck Operator Safety Evaluation 1.1

• Personnel

• Forklift Operator Evaluation

• Document No.

• Cargill

• Conducted on

  Date

• Trainer

• Sioux City, IA
  Address

Plant Vehicle

• Class of Forklift

  Select Class 1 Electric Class 2 Electric (Order picker) Class 3 Hand Truck Class 4 Indoor Class 5 Outdoor Class 6 Industrial Class 7 Rough Terrain

  • Class 1 Electric
  • Class 2 Electric (Order picker)
  • Class 3 Hand Truck
  • Class 4 Indoor
  • Class 5 Outdoor
  • Class 6 Industrial
  • Class 7 Rough Terrain

Daily Safety Inspection

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• The operator fully understands the capacity information plate?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• If a fault has been found, the lift truck must be parked up in a safe place and the key removed. The fault must be made to a member of the management team.

Operator Safety & Observation

• The operator mounts / dismounts correctly?

  Yes

  No

  N/A

• Uses the seatbelt correctly?

  Yes

  No

  N/A

• Keeps body parts within the confines of the vehicle?

  Yes

  No

  N/A

• Operator looks in the direction of travel?

  Yes

  No

  N/A

• Correct use of the horn when appropriate?

  Safe

  At Risk

  N/A

• Follows the correct procedures for an "unattended" vehicle?

  Yes

  No

  N/A

• Operator had good all round safety observation?

  Yes

  No

  N/A

Steering & Operating Controls

• Starts and stops smoothly?

  Yes

  No

  N/A

• Correct use of the steering assistor?

  Yes

  No

  N/A

• Travels unintentionally in the wrong direction?

  Safe

  At Risk

  N/A

• Brakes harshly / erratically?

  Safe

  At Risk

  N/A

• Releases the parking brake prior to moving off?

  Yes

  No

  N/A

• Operator rides the foot brake?

  Safe

  At Risk

  N/A

• Operates the hydraulic controls when the lift truck is in motion?

  Safe

  At Risk

  N/A

• Rough use of hydraulic controls?

  Safe

  At Risk

  N/A

• Operates and understands the controls?

  Safe

  At Risk

  N/A

Competency In Load Capacity

• Operator matches load with the trucks capacity?

  Yes

  No

  N/A

• Operator checks the load for stability?

  Yes

  No

  N/A

Manoeuvring & Transportation

• Forks to high when traveling?

  Safe

  At Risk

  N/A

• Forks to low when traveling?

  Safe

  At Risk

  N/A

• Operating in reverse, looking in the direction of travel to the correct ratio?

  Safe

  At Risk

  N/A

• Operates at a speed consistent with the type of load and working conditions?

  Safe

  At Risk

  N/A

• Operator performs safe maneuvering with the lift truck and load!

  Yes

  No

  N/A

Stacking & de-stacking

• Incorrect set down at a vertical face?

  Safe

  At Risk

  N/A

• Operator applies the park brake when operating the hydraulics?

  Safe

  At Risk

  N/A

• Operator applies neutral when operating the hydraulics?

  Safe

  At Risk

  N/A

• Fork arms central under the load?

  Safe

  At Risk

  N/A

• Fork arms not rubbing (entry / withdrawal)?

  Safe

  At Risk

  N/A

• Fork tips touch the stack / load?

  Safe

  At Risk

  N/A

• Forks / load not level?

  Safe

  At Risk

  N/A

• Load correctly stacked?

  Safe

  At Risk

  N/A

• Fork arms not fully inserted (undercut) ?

  Safe

  At Risk

  N/A

Parking

• The operator correctly applies the park brake?

  Safe

  At Risk

  N/A

• The operator sets the direction lever to the neutral position?

  Safe

  At Risk

  N/A

• The operator correctly apples forward tilt?

  Safe

  At Risk

  N/A

• The operator correctly lowers the fork arms?

  Safe

  At Risk

  N/A

• The manoeuvring wheels are in the straight position?

  Safe

  At Risk

  N/A

• The operator switches off and removes the key?

  Safe

  At Risk

  N/A

Assessment Recommendations & Evaluations

• Assessors evaluation of operator safety?

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Comments

Signatures

• Date and time of assessment

  Date

• Operator signature

  Sign

• Assessor signature

  Sign