Title Page

  • Name of Person Undergoing Evaluation

  • Conducted on

  • Location/Task

MHE Operation

  • MHE type/Fleet number

  • Pre Use Check Complete (Attach Photo)

  • Is the MHE being operated safely accordingly to training, observing hazards and work areas?

  • Is the operator wearing their seatbelt?

  • Is the operator maintaining a safe distance from other MHEs and pedestrians?

  • Is the operator free of any correctional measures required? (If so, add details in comments)

  • If a toolbox talk is required, enter the words of advice given: (if N/A write N/A in notes)

  • Name & Signature of Operator (by signing this you agree to the evaluation and any words of advice/ toolbox talk given)

  • Name & Signature of Evaluator

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.