Title Page

  • Operator Name

  • Evaluator Name

  • Evaluation Date

  • Crane make/model used during evaluation

  • Task performed during evaluation

Evaluation Checklist

  • Assembly / Disassembly Operations

  • Crane setup for operations

  • Cribbing / matting setup

  • Crane leveling (daily verification)

  • Adequately identified and avoided existing underground utilities

  • Crane setup / positioned to reduce boom radius requirements

  • Tail swing clearance verified

  • Swing radius protection in place

  • Fueling operations

  • Pre-use inspection

  • Performed pre-lift testing and requirements for personnel basket use

  • Demonstrated knowledge is weather affects of crane operation

  • Safely mounted and dismounted crane

  • Able to determine load weight

  • Properly evaluated and utilized load chart / line capacity

  • Demonstrate knowledge in rigging requirements

  • Utilized a tag line on all lifts except where it presented additional hazards

  • Positioned boom to the center of gravity of load

  • Adjusted boom for deflection prior to lift

  • Demonstrated knowledge in standard signals

  • Ensure safe swing path is maintained during lift (obstructions/personnel)

  • Operated the crane within its operational limitations / maintained operational control

  • Maintained safe operations regarding two-blocking the crane

  • Minimized dynamic loading during crane operations

  • Safely traveled crane with / without load

  • Kept personnel from hazardous areas during operation

  • Maintained adequate distance from electrical lines or had other required controls in place

  • Loaded/Unloaded trucks using safe work practices

  • Did not leave crane unattended while loaded

  • Performed dry run for critical lifts

  • Performed PM / Grease maintenance as required

  • Based on my evaluation the operator:

  • Evaluator Signature

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