HEO - Forklift - Field Exam

• Candidate Name - HEO Field Exam - Forklift

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• The performance verification is designed as one method to a evaluate job skills and safe work habits of a participant. The performance of the participant must be evaluated by a designated W.C. Spratt, Inc. evaluator at an authorized location. Candidates must have a minimum passing score of 90% to pass any field exam portion of the heavy equipment operator training program.

Employee Information

• Employee name:

• Employee number:

• Employee photo:

  Media

Forklift Equipment Type (Make and Model):

• From the manufacturers plate please obtain this information and enter here;

Operator Details

• If an operator has no proof of training held on record, they must not operate until proof of training competency has been proven.

• Has the operator had a valid certificate of training that has been passed or refreshed within the last three years?

  Yes

  No

  N/A

• Has the operator an up to date authorization to operate, signed and renewable annually?

  Yes

  No

  N/A

• Date of test or refresher course?

  Date

• Photo of that certification:

  Media

Pre-start Inspection:

• Did the operator verify all safety items are identified; such as the fire extinguisher, warning signs guards, etc:

  Yes

  No

  N/A

• Did the operator position barricades and appropriate warning signs?

  Yes

  No

  N/A

• Did the operator properly position the forklift for pre-start inspection?

  Yes

  No

  N/A

• Did the operator complete the daily pre-operation check list? (This is done using the appropriate form within the iauditor suite).

  Yes

  No

  N/A

Job Site Survey:

• Did the operator identify potential site hazards such as but not limited; to high-voltage lines or underground utilities?

  Yes

  No

  N/A

• Did the operator verify safety of equipment set up?

  Yes

  No

  N/A

Start-up and Warm-up of Forklift:

• Did the operator successfully start the engine?

  Yes

  No

  N/A

• Did the operator check the engine gauges for proper readings?

  Yes

  No

  N/A

• Did the operator check all controls for proper function such as but not limited to; steering, mast lift and tilt, telescope and travel?

  Safe

  At Risk

  N/A

• Did the operator properly document their findings on the required checklist?

  Safe

  At Risk

  N/A

Perform Basic Maneuvering Skills:

• Did the operator position the forklift as instructed for the exercise?

  Yes

  No

  N/A

• Was the operator able to travel unloaded with the forklift going forward for at least 50 feet?

  Yes

  No

  N/A

• Was the operator able to travel unloaded with the forklift going in reverse for at least 50 feet?

  Yes

  No

  N/A

• Was the operator able to accomplish a right turn of 90° while moving in a forward direction?

  Yes

  No

  N/A

• Was the operator able to accomplish a left turn of 90° while moving in a forward direction?

  Yes

  No

  N/A

• Was the operator able to accomplish a right turn of 90° while moving in the reverse direction?

  Yes

  No

  N/A

• Was the operator able to accomplish a left turn of 90° while moving in the reverse direction?

  Yes

  No

  N/A

• Was the operator able to accomplish a 360° tram steer to the right in the forward direction? (rough terrain forklift only)

  Yes

  No

  N/A

• Is the operator able to accomplish a crab steer as directed at least two full tire rotations (rough terrain forklifts only) ?

  Yes

  No

  N/A

• Is the operator able to raise, lower, and tilt the mast (fixed mast forklifts)

  Yes

  No

  N/A

• Is the operator able to raise, lower, and telescope in and out (telescoping boom forklifts) ?

  Yes

  No

  N/A

• Is the operator able to set the stabilizers (telescoping boom forklifts) ?

  Yes

  No

  N/A

Performing Lifting Operations:

• Is the operator able to easily position the forks under the load for lifting?

  Yes

  No

  N/A

• Is the operator able to raise the load into position?

  Yes

  No

  N/A

• Is the operator able to tilt the mast rearward for transport?

  Safe

  At Risk

  N/A

• Is the operator able to travel the assigned path to the load destination?

  Safe

  At Risk

  N/A

• Is the operator able to properly set the load in the assigned position?

  Yes

  No

  N/A

• Is the operator able to return the forklift to the designated area along the assigned path?

  Yes

  No

  N/A

Forklift Shut-Down:

• Is the operator able to move the forklift to the designated shutdown area?

  Safe

  At Risk

  N/A

• Is the operator able to properly shut down and secure the loader?

  Safe

  At Risk

  N/A

Safety:

• Did the operator use all necessary PPE properly?

  Safe

  At Risk

  N/A

• Did the operator properly place all safety notices for the exercise?

  Safe

  At Risk

  N/A

• Did the operator properly follow all safety checklist and site-specific safety requirements?

  Safe

  At Risk

  N/A

• Did the operator practice overall good safety procedures and use of the tools and assigned equipment?

  Safe

  At Risk

  N/A

Assessment Recommendations & Evaluations

• Has the operator successfully completed with positive results all of the previous criteria?

  Yes

  No

  N/A

• Please select the candidate operator's recommendation for this field exam:

  Pass

  Fail

• Please detail basis for failure:

• Please select future date for retest:

  Date

Signatures

• Candidate operator signature:

  Sign

• Assessor signature:

  Sign