NorSea Group Forklift Operators Periodic Assessment

• Conducted on

  Date

• Assessor Name

• Operatives Name

• Location
  Address

• The periodic assessment of operators must where ever possible be done without the operators knowledge. The assessment should reflect the operators day to day performance rather than their performance when they are under evaluation. It may be necessary to complete an assessment over the course of several days, where this is done, the date discussed with the employee should be given as the assessment date.

Pre Operation Planning

• Completed pre use checks on vehicle correctly

  Yes

  No

  Not Assessed

  Not Applicable

• Maintains three points of contact when mounting vehicle<br>

  Yes

  No

  Not Assessed

  Not Applicable

• Makes use of seat belt

  Yes

  No

  Not Assessed

  Not Applicable

• Adopts appropriate driving position

  Yes

  No

  Not Assessed

  Not Applicable

• Other comments

Hazard Awareness

• Looks in the direction of travel

  Yes

  No

  Not Assessed

  Not Applicable

• Sounds horn at blind spots

  Yes

  No

  Not Assessed

  Not Applicable

• Good use of peripheral vision

  Yes

  No

  Not Assessed

  Not Applicable

• Shows awareness of personnel and vehicles in area

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures delivery drivers are appropriately sited before beginning loading/unloading

  Yes

  No

  Not Assessed

  Not Applicable

• Drives in reverse or employs a banks-man when vision is impaired by load.

  Yes

  No

  Not Assessed

  Not Applicable

• Other comments

Driving Style

• Maintains safe distance from other vehicles

  Yes

  No

  Not Assessed

  Not Applicable

• Maintains a steady speed

  Yes

  No

  Not Assessed

  Not Applicable

• Maintains a safe speed

  Yes

  No

  Not Assessed

  Not Applicable

• Slows down when cornering

  Yes

  No

  Not Assessed

  Not Applicable

• Avoids abrupt movements

  Yes

  No

  Not Assessed

  Not Applicable

• Apples break in a controlled manner

  Yes

  No

  Not Assessed

  Not Applicable

• Keeps forks at correct height when traveling

  Yes

  No

  Not Assessed

  Not Applicable

• Keeps arms and legs within confines of the vehicle at all times

  Yes

  No

  Not Assessed

  Not Applicable

• Looks over both shoulders before reversing

  Yes

  No

  Not Assessed

  Not Applicable

• Other comments

Control of Load

• Does not exceed safe working load

  Yes

  No

  Not Assessed

  Not Applicable

• Lowers heavy loads slowly

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures adequate clearance

  Yes

  No

  Not Assessed

  Not Applicable

• Approaches load squarely

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures load is trimmed centrally

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures forks are fully engaged

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures load is on backplate

  Yes

  No

  Not Assessed

  Not Applicable

• Other comments

Parking

• Vehicle is parked up in a safe location

  Yes

  No

  Not Assessed

  Not Applicable

• Ensures correct forward tilt and forklift height before switching off.

  Yes

  No

  Not Assessed

  Not Applicable

• Operator removes keys from vehicle

  Yes

  No

  Not Assessed

  Not Applicable

Assessment Feedback

• Feedback to operative, identifying gaps in competency and comments on positive development.

• Feedback from operative on assessment.

Completion signoff

• Signature of assessor:

  Sign

• Signature of colleague:

  Sign