IAEC - Bucket Rescue (version 4)

IAEC - Bucket Rescue

• Cooperative

• Conducted on

  Date

• Safety Trainer Performing Evaluation

• Location
  Address

Bucket Rescue

• The objective of the bucket rescue evaluation is for the cooperative employee to show their proficiency with the operation of the lower controls and tilting the bucket in the event that a rescue is needed during daily work procedures. The employee may also be asked specific questions pertaining to rescue techniques including, but not limited to, MayDay procedures, hypothetical injury scenarios, CPR, FA, AED and rigging.

• The employee operates the lower controls on the truck properly and proficiently

• The employee Tilts the bucket proficiently from upper and or lower controls

• The employee answered specific rescue procedure questions accurately

• Additional information as it relates to the questions above

Employee name and signature - By signing my name below, I agree that I have successfully completed the requirements for the annual Bucket rescue evaluation.

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

Employee(s) listed below did not successfully complete the requirements needed for Bucket Rescue. Employee signature below verifies agreement.

• The employee operates the lower controls on the truck properly and proficiently

  Yes

  No

  N/A

• The employee Tilts the bucket proficiently from upper and or lower controls

  Yes

  No

  N/A

• The employee answered specific rescue procedure questions accurately

  Yes

  No

  N/A

• Additional information as it relates to the questions above

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

IAEC Safety Trainer Signature

• Matt Pociask

  Sign

• Jim Wolfe

  Sign

• Scott Meinecke

  Sign

• Jason Thorson

  Sign