Operator Proficiency Evaluation - GES

• Operator Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Equipment

• Type of equipment?

  Select RTFL (Skytrack) MEWP (with boom) backhoe / mini excavator Skid Steer MEWP (scissor lift) Other

  • RTFL (Skytrack)
  • MEWP (with boom)
  • backhoe / mini excavator
  • Skid Steer
  • MEWP (scissor lift)
  • Other

Operator Details

• If an operator has no proof of training held on record, they can operate the equipment under supervision once this form has been sent to the safety and training departments, who then can evaluate the operator and issue or update the operator certification.

• Operator has taken the theoretical portion of the training and is aware of company procedures e.i. inspections, choking wheels, stability?

  Yes

  No

  N/A

• Date of theoretical training course?

  Date

• Does the operator have experience operating this type of equipment.

  Yes

  No

  N/A

• How many years of experience?

• Operator Signature

  Sign

Daily Safety Inspection

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• The operator fully understands the capacity information plate including lateral load?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• The operator completes a workplace inspection holes, drop off, overhead etc?

  Yes

  No

  N/A

• Operator performs visual checks?

  Yes

  No

  N/A

• Operator performs function check of the controls?

  Yes

  No

  N/A

• If a fault has been found, the equipment must be parked in a safe place and the fault must reported to the jobsite supervisor.

Operator Safety Evaluation

• The operator:

• Mounts / dismounts correctly

  Yes

  No

  N/A

• Is competent and smooth operation of controls

  Yes

  No

  N/A

• Keeps body parts within the confines of the vehicle while in motion.

  Yes

  No

  N/A

• Is aware of all clearances?

  Yes

  No

  N/A

• Looks in the direction of travel

  Yes

  No

  N/A

• Travels with platform at a safe height?

• Positions platform at a safe distance from obstacles?

  Yes

  No

  N/A

• Checks below before lowering the platform?

  Yes

  No

  N/A

• Uses a harness attached to the anchor point in the basket. (boom lift)

  Yes

  No

  N/A

• Follows company procedures and manufacturer recommendations.

  Yes

  No

  N/A

• Is the operator familiar with the specific equipment?

  Media

Steering & Operating Controls

• The operator:

• Maintains control at all times?

  Yes

  No

  N/A

• Uses controls correctly

  Yes

  No

  N/A

• Operates and understands the specific controls of the equipment.

  Yes

  No

  N/A

Risk Assessment

• Operator Knows the risks associated with operating equipment

  Yes

  No

  N/A

• Name risk associated with platform operation

  Select Tip over hazards caught in between hazards falls from the basket Material and tools falling off platform

  • Tip over hazards
  • caught in between hazards
  • falls from the basket
  • Material and tools falling off platform

• Operator shall only operate MEWP's that he is authorized, trained and familiarized with prior to safe operation of the platform.

• Is operator familiar with emergency procedures?

  Yes

  No

  N/A

• What are the emergency procedures required when operating MEWP's ?

  Select Entangled Platform Platform Failure Suspension trauma Rescue Procedure Self rescue

  • Entangled Platform
  • Platform Failure
  • Suspension trauma
  • Rescue Procedure
  • Self rescue

Assessment Recommendations

• Overall Evaluation of the Operator

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Does the operator comply with the overall safe operating procedures to prevent incidents?

  Pass

  Fail

  N/A

• Recommendations

ACKNOWLEDGMENT

• Full Name and Signature of Operator

  Sign

• Full Name and Signature of Evaluator

  Sign

Operator Details

• Operator ha taken the theoretical portion of the training and is aware of company procedures e.i. inspections, familiarization, stability?

  Yes

  No

  N/A

• Date of theoretical training course?

  Date

• Does the operator have experience operating this type of equipment.

  Yes

  No

  N/A

• How many years of experience?

• Operator Signature

  Sign

Daily Safety Inspection

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• The operator fully understands the capacity information plate including at different ranges?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• Operator is familiar with stability triangle?

  Yes

  No

  N/A

• The operator completes a workplace inspection holes, drop off, overhead etc?

  Yes

  No

  N/A

• Operator performs visual checks?

  Yes

  No

  N/A

• Operator performs function check of the controls?

  Yes

  No

  N/A

• Operator wears seat belt?

  Yes

  No

  N/A

• If an fault has been found, the equipment must be parked in a safe place and the fault must reported to the jobsite supervisor.

Operating Procedures

• The operator:

• Mounts / dismounts correctly

  Yes

  No

  N/A

• Is competent and smooth operation of controls

  Yes

  No

  N/A

• Looks back before moving?

  Yes

  No

  N/A

• Is aware of all clearances (side, overhead, rear)?

  Yes

  No

  N/A

• Looks in the direction of travel

  Yes

  No

  N/A

• Travels with load and forks at a safe height?

• Travels at a safe speed for all conditions?

  Yes

  No

  N/A

• Checks load before lifting it?

  Yes

  No

  N/A

• Places load on forks correctly and cradles the load (tilt)

  Yes

  No

  N/A

• Follows company procedures and manufacturer recommendations.

  Yes

  No

  N/A

• Places and pulls out load correctly?

  Yes

  No

  N/A

Assessment Recommendations & Evaluations

• Overall Evaluation of the Operator

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Recommendations

ACKNOWLEDGMENT

• Full Name and Signature of Operator

  Sign

• Full Name and Signature of Evaluator

  Sign

• If an operator has no proof of training held on record, they must not operate the equipment until the safety and training departments can evaluate them and issue an operator certification. If they have proof of training from another company and it is not expired, they can operate equipment under supervision once this form has been sent to the safety and training departments who then can evaluate the operator and issue or update the operator certification.

Operator Details

• If an operator has no proof of training held on record, they can operate the equipment under supervision until safety department can evaluate them and issue an operator certification.

• Operator has taken the theoretical portion of the training and is aware of company procedures e.i. inspections, center of gravity, stability, sideslope and grade?

  Yes

  No

  N/A

• Date of theoretical training course?

  Date

• Does the operator have experience operating this type of equipment.

  Yes

  No

  N/A

• How many years of experience?

• Operator Signature

  Sign

Daily Safety Inspection

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• The operator fully understands the capacity information plate including stability?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• The operator completes a workplace inspection holes, drop off, overhead etc?

  Yes

  No

  N/A

• Operator performs visual checks?

  Yes

  No

  N/A

• Operator performs function check of the controls?

  Yes

  No

  N/A

• If an fault has been found, the equipment must be parked in a safe place and the fault must reported to the jobsite supervisor.

Operating Procedures

• The operator:

• Mounts / dismounts correctly

  Yes

  No

  N/A

• Is competent and smooth operation of controls

  Yes

  No

  N/A

• Sets up correctly

  Yes

  No

  N/A

• ensures ground is firm and stable

  Yes

  No

  N/A

• cutting edge at correct angle

  Yes

  No

  N/A

• Curls back to secure load?

• Swings boom safely?

  Yes

  No

  N/A

• Is aware of all clearances?

  Yes

  No

  N/A

• Correct placement of soil?

  Yes

  No

  N/A

• Levels bottom of trench

  Yes

  No

  N/A

• Operates and understands the specific controls of the equipment.

  Yes

  No

  N/A

• Follows company procedures and manufacturer recommendations.

  Yes

  No

  N/A

Risk Assessment

• Operator Knows the risks associated with operating the backhoe

  Yes

  No

  N/A

• Review risks associated with platform operation

  Select Utility location Prior to excavating Tip Over hazards Caught in between hazards Pedestrian hazards Proper procedure for mounting and dismounting

  • Utility location Prior to excavating
  • Tip Over hazards
  • Caught in between hazards
  • Pedestrian hazards
  • Proper procedure for mounting and dismounting

• Operator shall only operate equipment that he is authorized, trained and familiarized with prior to operation.

• Is operator familiar with emergency procedures?

  Yes

  No

  N/A

• What are the emergency procedures required when operating MEWP's ?

  Select Procedure in case of tip over Area flagged to prevent pedestrians to from entering the danger zone Proper use of safety devices

  • Procedure in case of tip over
  • Area flagged to prevent pedestrians to from entering the danger zone
  • Proper use of safety devices

General safety

• Is aware of activity in the work area

  Yes

  No

  N/A

• Ropes area as required

  Yes

  No

  N/A

• Uses all safety devices (boom transport & pivot locks)

  Yes

  No

  N/A

Assessment Recommendations & Evaluations

• Overall Evaluation of the Operator

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Recommendations

ACKNOWLEDGMENT

• Full Name and Signature of Operator

  Sign

• Full Name and Signature of Evaluator

  Sign

• If an operator has no proof of training held on record, they must not operate the equipment until the safety and training departments can evaluate them and issue an operator certification. If they have proof of training from another company and it is not expired, they can operate equipment under supervision once this form has been sent to the safety and training departments who then can evaluate the operator and issue or update the operator certification.

OPERATOR EXPERIENCE

• Operator has taken the theoretical portion of the training and is aware of company procedures e.i. inspections, choking wheels, stability?

• Date of theoretical training course?

  Date

• Does the operator have experience operating this type of equipment?

  Yes

  No

  N/A

• How many years of experience?

• Operator Signature

  Sign

DAILY SAFETY INSPECTION

• The operator completes the safety Pre-shift safety inspection correctly

  Yes

  No

  N/A

• The operator fully understands the capacity information plate including lateral load?

  Safe

  At Risk

  N/A

• The operator understands the correct fault reporting procedures.

  Safe

  At Risk

  N/A

• The operator completes a workplace inspection holes, drop off, overhead etc.

  Safe

  At Risk

  N/A

• Operator performs visual checks.

  Safe

  At Risk

  N/A

• Operator performs function check of the controls.

  Safe

  At Risk

  N/A

• If a fault has been found, the equipment must be parked in a safe place and the fault must reported to the jobsite supervisor.

OPERATOR SAFETY EVALUATION

• Does the operator:

• Mounts / dismounts correctly

  Safe

  At Risk

  N/A

• Is competent and smooth operation of controls

  Safe

  At Risk

  N/A

• Keeps body parts within the confines of the vehicle while in motion.

  Safe

  At Risk

  N/A

• Is aware of all clearances?

  Safe

  At Risk

  N/A

• Looks in the direction of travel?

  Safe

  At Risk

  N/A

• Travels with platform at a safe height?

  Safe

  At Risk

  N/A

• Positions platform at a safe distance from obstacles?

  Safe

  At Risk

  N/A

• Checks below before lowering the platform?

  Safe

  At Risk

  N/A

• Uses a harness attached to the anchor point in the basket. (boom lift)

  Safe

  At Risk

  N/A

• Follows company procedures and manufacturer recommendations.

  Safe

  At Risk

  N/A

STEERING AND OPERATING CONTROLS

• Does the operator:

  Yes

  No

  N/A

• Always maintains control of the equipment

  Yes

  No

  N/A

• Uses controls correctly

  Yes

  No

  N/A

• Operates and understands the specific controls of the equipment.

  Yes

  No

  N/A

• Has become familiar with the specific equipment operation, capacities, control layout, company procedures and manufacturer recommendations.

  Yes

  No

  N/A

• Is the operator familiar with the specific equipment?

  Media

RISK ASSESMENT

• Operator Knows the risks associated with operating equipment

  Yes

  No

  N/A

• Name risk associated with platform operation

  Select Tip over hazards caught in between hazards falls from the basket Material and tools falling off platform

  • Tip over hazards
  • caught in between hazards
  • falls from the basket
  • Material and tools falling off platform

• Operator shall only operate MEWP's that he is authorized, trained and familiarized with prior to safe operation of the platform.

• Is operator familiar with emergency procedures?

  Yes

  No

  N/A

• What are the emergency procedures required when operating MEWP's ?

  Select Entangled Platform Platform Failure Suspension trauma Rescue Procedure Self rescue

  • Entangled Platform
  • Platform Failure
  • Suspension trauma
  • Rescue Procedure
  • Self rescue

ASSESMENTS AND RECOMMENDATIONS

• Overall Evaluation of the Operator

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Does the operator comply with the overall safe operating procedures to prevent incidents?

  Pass

  Fail

  N/A

• Recommendations

  Pass

  Fail

  N/A

ACKNOWLEDGMENT

• Full Name and Signature of Operator

  Sign

• Full Name and Signature of Evaluator

  Sign

• If an operator has no proof of training held on record, they must not operate the equipment until the safety and training departments can evaluate them and issue an operator certification. If they have proof of training from another company and it is not expired, they can operate equipment under supervision once this form has been sent to the safety and training departments who then can evaluate the operator and issue or update the operator certification.

Operator Details

• If an operator has no proof of training held on record, they can operate the equipment under supervision until safety department can evaluate them and issue an operator certification.

• Operator has taken the theoretical portion of the training and is aware of company procedures e.i. inspections, center of gravity, stability, sideslope and grade?

  Safe

  At Risk

  N/A

• Date of theoretical training course?

  Safe

  At Risk

  N/A

• Does the operator have experience operating this type of equipment.

  Yes

  No

  N/A

• How many years of experience?

• Operator Signature

  Sign

Visual Checks

• Bucket grapple and lift arms

• Condition of all pins, cylinders and hoses

• Guards covers and decals

• cab/ROPS, windows, & steering

• Fluid Levels and leaks

Equipment

• What type of equipment is going to be operated?

  Yes

  No

  N/A

• Equipment type

  Select 5mall Frame skid steer less than 1700 lbs. Medium frame 1750-2200 LBS. Large Frame more than 2200 LBS

  • 5mall Frame skid steer less than 1700 lbs.
  • Medium frame 1750-2200 LBS.
  • Large Frame more than 2200 LBS

• Manufacturer

  Select Bobcat Case Deere Terex CAT Other

  • Bobcat
  • Case
  • Deere
  • Terex
  • CAT
  • Other

Operator Familiarization

• seat belt / lap bar (on)

• Instrument Familiarization (readings warning lights)

• All hydraulic functions (lift, tilt, / grapple)

• Brakes and steering

• Is operator familiar with safe operating procedures?

  Safe

  At Risk

  N/A

Operating Evaluation

• Proper gear and direction

• Explain reason for deficiency

• Bucket and Grapple at a safe height

• Explain reason for deficiency

  Yes

  No

  N/A

• Explain reason for deficiency

• Approaches load correctly

• Explain reason for deficiency

• secures load / safe travel height

• Explain reason for deficiency

• Operator is aware of all clearances

• Explain reason for deficiency

• Checks back before moving

• Explain reason for deficiency

• Operates at a proper speed for the conditions

• Explain reason for deficiency

• Drives with a clear vision

• Explain reason for deficiency

• Operates attachment safely and correctly (If any attachments are used)

  Safe

  At Risk

  N/A

• Operator is aware of activity in work area?

• Explain reason for deficiency

• Gives pedestrians the right of way

• Explain reason for deficiency

  Yes

  No

  N/A

• Operator uses all safety devices (lift arm support / steering lock)

• Explain reason for deficiency

  Yes

  No

  N/A

• Proper procedures for mounting and dismounting the vehicle

• Explain reason for deficiency

Work Specific Topics

• Are there any worksite specific topics or hazards that operator must be aware of?

  Yes

  No

  N/A

• Please explain such topics and a plan to approach them?

Risk Assessment

• Operator Knows the risks associated with operating the backhoe

  Yes

  No

  N/A

• Review risks associated with platform operation

  Tip over hazards

  Caught in between hazards

  Struck by hazards

• Operator shall only operate equipment that he is authorized, trained and familiarized with prior to operation.

Assessment Recommendations & Evaluations

• Overall Evaluation of the Operator

  Yes

  No

  N/A

• Recommendations

  Yes

  No

  N/A

ACKNOWLEDGMENT

• Full Name and Signature of Operator

  Yes

  No

  N/A

• Full Name and Signature of Evaluator

  Yes

  No

  N/A