Information
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Equipment Type and Model
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Conducted on
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Prepared by
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Employee has on the proper personal protective equipment
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Employee completed a per-shift inspection of the equipment<br>
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Any covers, guards, caps or safety devices removed for purposes of inspection have been replaced.
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Employee can identify and understands the operation of each control.<br><br>
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Employee performed a function test of each control.<br>
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Employee can identify and understand all placards, decals, warnings and instructions for the equipment.<br><br><br>
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Employee inspected the area for hazards prior to operation.
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Employee appears comfortable operating the equipment smoothly without any jerking or other unsafe movements.<br><br><br><br>
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Employee appears to have the proper eye, hand, and foot coordination to safely operate the equipment.<br>
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Employee demonstrates a working knowledge of the equipment.<br>
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Employee knows the procedures for reporting defects, malfunctions or other problems with the equipment.<br>
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Employee demonstrates proper mounting and dismounting procedures for the equipment involved.<br>
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Employee Authorized to operate this equipment.<br>
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Employee to be retrained on the following items prior to authorization:
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Operator signature
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Observer's signature
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Operator's picture
