Title Page

  • Conducted on

  • Prepared by

  • Location Of Assessment/ Review
  • Name of Operator Authorised

  • Name of Operator

  • Employer if not JFL

  • Type of Powered Industrial Truck Operator Authorised to Operate

  • Details of type of Powered Industrial Lifting Truck

  • Locations Operators is Authorised to Operate

  • Details of other locations

Training

  • Training details

  • Expiry Date of Training

  • Provide photo of training certificate(s)

Location Awareness and Rule

  • The Authorised Operator has been trained in all the Site rules

  • The Authorised Operator has read and signed all relevant Safe systems of Work.

Competency Assessment - Using Powered Industrial Truck Operators Performance Evaluation

  • Competency assessment completed and Operator has achieved an adequate score to demonstrate suitable competency

  • A suitable frequency of Operator performance evaluation has been set

Fitness to Operate Powered Industrial Trucks

  • Operator has passed a Drugs and Alcohol test

  • Are there any health issues which may affect the Operators cabilty to safely Operate

  • Provide details of Suitable adjustments - indicate if permanent or temporary.

Sign Off Section

  • Operator sign to demonstrate they understand the rules and safety measures required for operating a Powered Industrial Truck for Jurassic Fibre. They undertake to operate these safely and inform manager if they have any health conditions requiring prescription medication or if they know of any other concern that could affect ability to operate these safely.

  • Manager sign to demonstrate that the assessment has been fair and robust and they feel the Operator is competent to operate the Powered Industrial Trucks indicated and that he will undertake to ensure suitable competency assessments are undertaken to monitor compliance with rules and expectations.

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.