POWERED INDUSTRIAL TRUCK OPERATORS PERFORMANCE EVALUATION

• Type of Truck

• Date conducted

  Date

• Conducted by

• Location
  Address

• Type of Assessment Undertaken

  Select Competency Assessment Routine Operator Monitoring Responsive due to Incident or Concern Raised (third party) Responsive due to Operator Request.

  • Competency Assessment
  • Routine Operator Monitoring
  • Responsive due to Incident or Concern Raised (third party)
  • Responsive due to Operator Request.

• Checks undertaken on training certification including renewal dates - Photo attached for new persons or new certificate.

  Select Certificate provided relevant to FLT type and time scale. Certificate provided for relevant FLT but need renewing in next 3 months. Certificate provided but close to or over the expiry date. Certificate not provided but proof of training seen

  • Certificate provided relevant to FLT type and time scale.
  • Certificate provided for relevant FLT but need renewing in next 3 months.
  • Certificate provided but close to or over the expiry date.
  • Certificate not provided but proof of training seen

• Activities Being Assessed

  Select Unloading/ Loading Palletized Goods from/ too trucks Unloading / Loading Reels from /too Trucks Unloading / Loading goods from other vehicles Moving Palletized goods in yard Moving Reels in Yard Bring goods into goods in and placing on ground Taking good out of store from the ground to the ground Stacking and unloading good on storage racks Other

  • Unloading/ Loading Palletized Goods from/ too trucks
  • Unloading / Loading Reels from /too Trucks
  • Unloading / Loading goods from other vehicles
  • Moving Palletized goods in yard
  • Moving Reels in Yard
  • Bring goods into goods in and placing on ground
  • Taking good out of store from the ground to the ground
  • Stacking and unloading good on storage racks
  • Other

• Provide detail of activity

• Daily Inspection -Performed at the Beginning of Shift or Day?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Operator has correct PPE on and is wearing it correctly.

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Operator has Assessed the Work Area and Removed Obstructions /Hazards?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Operator has Taken Account of Weather Conditions eg wipers used in rain,

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Seatbelt Worn When Operating Powered Industrial Truck?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Shows Familiarity with Controls?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Slowed Down at Intersections?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Sounded Horn at Intersections?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Obeyed Signs?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Kept a Clear View of Direction of Travel?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Turned Corners Correctly - Was Aware or Rear-end Swing?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Yielded to Pedestrians?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Drove Under Control and Within Proper Traffic Aisles?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Approached Load Correctly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Lifted Load Correctly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Maneuvered Correctly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Travelled with Load at Proper Height?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Lowered Load Smoothly/Slowly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Stop Smoothly/ Completely?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Load Balanced Correctly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Forks Under Load All the Way?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Carried Parts/ Stock in approved Containers?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Checked Bridge Plates / Ramps?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Placed Loads Within Designated Areas?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Stacked Loads Evenly and Neatly?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Checked Loads Weights?

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Forks on Floor When Parked, Controls in Neutral, Brake Set, Power Off.

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

• Keys removed when leaving the Powered Industrial Truck

  Select Good level of compliance Generally compliant but some learning No significant operator error N/A

  • Good level of compliance
  • Generally compliant but some learning
  • No significant operator error
  • N/A

RATING SYSTEM AND REEVALUATION REQUIREMENTS

• NUMBER OF SKILLS MISSED AND REEVALUATION REQUIRED

  Select 0 - 2 SKILLS MISSED - good monitor minimum every 6 months 3 - 4 SKILLS MISSED - requires monitoring minimum of every 2 months 5 - 6 SKILLS MISSED - Have recorded one to one and monitor monthly 6 OR MORE SKILLS MISSED DO NOT AUTHORIZE - Requires more training/ mentoring

  • 0 - 2 SKILLS MISSED - good monitor minimum every 6 months
  • 3 - 4 SKILLS MISSED - requires monitoring minimum of every 2 months
  • 5 - 6 SKILLS MISSED - Have recorded one to one and monitor monthly
  • 6 OR MORE SKILLS MISSED DO NOT AUTHORIZE - Requires more training/ mentoring

• I consider this operator suitable to be or remain an authorised Operator

  Select Yes No N/A Yes with mentoring and / or supervision

  • Yes
  • No
  • N/A
  • Yes with mentoring and / or supervision

• Signature of assessor

  Sign