Operator Evaluation

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Operator

• Type of Equipment

• Evaluation

  New Evaluation

  Annual Evaluation

  Re-Evaluation (Post Incident)

Pre-start Inspection

• Is the machine positioned properly for the pre-start inspection?

  Yes

  No

  N/A

• Did the operate all safety equipment is in place and in good condition? (Fire Extinguisher, Spill Kit, Guards, etc.)

  Yes

  No

  N/A

• Did operator identify location of fluid levels, grease fittings, etc?

  Yes

  No

  N/A

• Did operator check for any fluid leaks on the tanks, lines, cylinders, etc?

  Yes

  No

  N/A

• Did the operator complete the equipment inspection checklist?

  Yes

  No

  N/A

Job Site Survey

• Did the operator identify potential hazards? (utilities, grade changes, structure, etc.)

  Yes

  No

  N/A

• Did the operator identify and verify grade stakes?

  Yes

  No

  N/A

• Did the operator properly position the equipment for operation?

  Yes

  No

  N/A

Perform Basic Maneuvering Skills

• Did operator position equipment in proper position to complete the task?

  Yes

  No

  N/A

• Did operator demonstrate a clear understand of all equipment controls?

  Yes

  No

  N/A

• Did operator demonstrate the understanding of travel lanes throughout the jobsite?

  Yes

  No

  N/A

• Did the operator position the equipment properly in the "loading" and "unloading" zone?

  Yes

  No

  N/A

Perform Operation Skills

• During controlled operations did the operator perform all tasks safely and skillfully?

  Yes

  No

  N/A

• Did the operator use attachments properly?

  Yes

  No

  N/A

Machine Shut-Down

• Did the operator move the equipment to the proper shut-down location?

  Yes

  No

  N/A

• Did the operator properly shut-down and secure the equipment?

  Yes

  No

  N/A

Safety

• Use of proper PPE? (including seat belt)

  Yes

  No

  N/A

• Properly barricade the area is needed? Signs, caution tape, etc.

  Yes

  No

  N/A

• Properly followed all safety checklists and site specific safety requirement?

  Yes

  No

  N/A

• Practiced good safety procedures in use of tools and equipment?

  Yes

  No

  N/A

Comments/Reason for Evaluation

• undefined

Signature of Evaluator

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