POWERED INDUSTRIAL TRUCK OPERATORS PERFORMANCE EVALUATION

• DOCUMENT NO.

• TYPE OF TRUCK

• CLIENT

• CONDUCTED ON

  Date

• PREPARED BY

• LOCATION
  Address

• EMPLOYEE NAME

• SHOWS FAMILIARITY WITH CONTROLS?

  Yes

  No

  N/A

• GAVE PROPER SIGNALS WHEN TURNING?

  Yes

  No

  N/A

• SLOWED DOWN AT INTERSECTIONS?

  Yes

  No

  N/A

• SOUNDED HORN AT INTERSECTIONS?

  Yes

  No

  N/A

• OBEYED SIGNS?

  Yes

  No

  N/A

• KEPT A CLEAR VIEW OF DIRECTION OF TRAVEL?

  Yes

  No

  N/A

• TURNED CORNERS CORRECTLY - WAS AWARE OF REAR-END SWING?

  Yes

  No

  N/A

• YIELDED TO PEDESTRIANS?

  Yes

  No

  N/A

• DROVE UNDER CONTROL AND WITHIN PROPER TRAFFIC AISLES?

  Yes

  No

  N/A

• APPROACHED LOAD PROPERLY?

  Yes

  No

  N/A

• LIFTED LOAD PROPERLY?

  Yes

  No

  N/A

• MANEUVERED PROPERLY?

  Yes

  No

  N/A

• TRAVELED WITH LOAD AT PROPER HEIGHT?

  Yes

  No

  N/A

• LOWERED LOAD SMOOTHLY/SLOWLY?

  Yes

  No

  N/A

• STOPS SMOOTHLY/COMPLETELY?

  Yes

  No

  N/A

• LOAD BALANCED PROPERLY?

  Yes

  No

  N/A

• FORKS UNDER LOAD ALL THE WAY?

  Yes

  No

  N/A

• CARRIED PARTS/STOCK IN APPROVED CONTAINERS?

  Yes

  No

  N/A

• CHECKED BRIDGE PLATES/RAMPS?

  Yes

  No

  N/A

• PLACED LOADS WITHIN DESIGNATED AREAS?

  Yes

  No

  N/A

• STACKED LOADS EVENLY AND NEATLY?

  Yes

  No

  N/A

• DROVE BACKWARD WHEN REQUIRED?

  Yes

  No

  N/A

• CHECKED LOAD WEIGHTS?

  Yes

  No

  N/A

• FORKS ON FLOOR WHEN PARKED, CONTROLS IN NEUTRAL, BRAKE SET, POWER OFF

  Yes

  No

  N/A

• DAILY INSPECTION - PERFORMED AT THE BEGINNING OF SHIFT OR DAY?

  Yes

  No

  N/A

• WORE SEATBELT WHEN OPERATING POWERED INDUSTRIAL TRUCK?

  Yes

  No

  N/A

RATING SYSTEM AND REEVALUATION REQUIREMENTS

• NUMBER OF SKILLS MISSED AND REEVALUATION REQUIRED

  0 - 2 SKILLS MISSED 3 YEARS

  3 - 4 SKILLS MISSED ANNUALLY

  5 - 6 SKILLS MISSED 6 MONTHS

  6 OR MORE SKILLS MISSED DO NOT AUTHORIZE - RETAKE TRAINING PROGRAM