OSHA Forklift Evaluation

• Person Being Evaluated

• Person Completing the Evaluation

• Conducted on

  Date

Formal Instruction

• Has this person completed the Workday LMS training?

  Yes

  No

• Stop this evaluation and have employee complete the Workday training before completing this evaluation.

• Date Completed:

  Date

Pre‐Use Visual Checks

• Controls (in safe positions)

  Yes

  No

• Fluid levels /leaks (engine or battery); damage to LPG cylinder, valves

  Yes

  No

• Forks, carriage, mast, chains, sprockets, hoses and overhead guard

  Yes

  No

• Wheels and tires

  Yes

  No

• Safety decals, capacity plate, guards, covers

  Yes

  No

• Safety devices (seat belt/harness)

  Yes

  No

Pre‐use Operational Checks

• Instruments (horn and lights)

  Yes

  No

Basic Operating Procedures

• Operate the controls competently and smoothly

  Yes

  No

• Travel with load/forks at a safe height

  Yes

  No

• Travels at safe speeds in all conditions

  Yes

  No

• Keep clear view of path of travel

  Yes

  No

• Maintain awareness of all clearances (overhead, side and rear)

  Yes

  No

• Maintain control at all times

  Yes

  No

• Check rear clearances before moving

  Yes

  No

• Start all turns in proper position

  Yes

  No

• Checks load before lifting

  Yes

  No

• Avoids bumping or pushing load

  Yes

  No

• Places and pulls out of load correctly

  Yes

  No

• Park correctly and safely

  Yes

  No

General Safety

• Sound horn when necessary

  Yes

  No

• Yield to pedestrians

  Yes

  No

• Keep body inside operating compartment

  Yes

  No

• Use all safety devices

  Yes

  No

• Competently refuel or recharge forklift

  Yes

  No

• Operator Signature:

  Sign

• Instructor Signature:

  Sign

• Operator successfully completed forklift operator training

  Yes

  No

• What follow up training is needed?