Information
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REC NAME
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Conducted on
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Prepared by
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Location
SAFETY INFORMATION
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Did the operator attend classroom refresher training?
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Did the operator adequately perform a pre trip inspection?
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Checked that the forklift is in good operating condition - Wheels, foot brake, parking brake, hydraulics, forks etc.
Checked that all safety features are operating - Strobe, flashers, horn, back up alarm, seatbelt etc. -
Is there a fire extinguisher on this forklift with a recent inspection date?
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Most recent inspection date
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Were any deficiencies identified during pre trip inspection?
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Is the operator wearing the required PPE to operate the equipment at this location?
Fork Truck Information
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Type of equipment? (Standard forklift, skidsteer, other?)
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- Standard forklift
- Skidsteer
- Tractor
- Other
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Make?
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Model?
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Serial Number?
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Capacity?
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Does this forklift have LP as a fuel source?
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Has there been any modifications made (not by the MFG) to the forklift?
COURSE NAVIGATION
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Did the operator successfully complete the obstacle course?
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Picture of the course Layout used for this training
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Did the operator safely park the forklift upon completion of the course? (including turning off the LP if applicable?)
Signatures
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
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Operators Signature
SAFETY TRAINER SIGNATURE
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Add signature