Forklift Truck Operator Safety Evaluation 1.1

• Conducted on

  Date

• Prepared by:

• Employee Name:

Plant Vehicle

• Type of plant equipment?

  Select Counterbalance forklift Hand Truck (reach/straddle)

  • Counterbalance forklift
  • Hand Truck (reach/straddle)

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 reported to a member of maintenance and their supervisor.

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

Steering & Operating Controls

• Starts and stops smoothly?

  Yes

  No

  N/A

• Travels in the direction of best visibility? ( if forward travel has an obstructed view the operator travels in reverse)

  Safe

  At Risk

  N/A

• Releases the parking brake prior to taking 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

• 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 are 6~8 inches high when traveling?

  Yes

  No

  N/A

• When traveling in reverse, the operator is looking in the direction of travel?

  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 manoeuvring with the lift truck and load!

  Yes

  No

  N/A

Stacking & de-stacking

• 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 are 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 lowers the fork arms?

  Safe

  At Risk

  N/A

• The operator correctly apples forward tilt?

  Safe

  At Risk

  N/A

• The operator switches off the key?

  Safe

  At Risk

  N/A

Assessment Recommendations & Evaluations

• Assessors evaluation of operator safety?

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Comments

Signatures

• Employee Signature

  Sign

• Assessor signature

  Sign