Pre-Training Course Operator Profile for Forklift Truck Training

• Name of Operator requiring Training

• Operator's Date of Birth

• Date form completed

  Date

• Name of Individual completing form

• Name of Organisation the Individual completing this form works for

• Signature of Individual completing form

  Sign

• Q1.1 Make and Model of Forklift Truck that Operator will be trained on

• Q1.2 Have you had any Forklift Truck Training in the past?

  Yes

  No

  N/A

• Q1.3 When was the last training completed on the type of truck this training is proposed to be taken on?

  Select Training undertaken within last 12 months Training undertaken within last 2 years Training undertaken over 2 years ago Training undertaken over 3 years ago Training undertaken over 4 years ago Training undertaken over 5 years ago Never had a Training Course

  • Training undertaken within last 12 months
  • Training undertaken within last 2 years
  • Training undertaken over 2 years ago
  • Training undertaken over 3 years ago
  • Training undertaken over 4 years ago
  • Training undertaken over 5 years ago
  • Never had a Training Course

• Q1.4 Can you provide a Copy of your Training Certificates?

  Yes

  No

  N/A

• Please select the Forklift Truck Types which you have Operator Training Certificates for

  Select Counterbalance Reach Truck Pivot Steer(aka Bendy) Side Loader Multi - Directional Tele Truck Very Narrow Aisle Truck (aka VNA)

  • Counterbalance
  • Reach Truck
  • Pivot Steer(aka Bendy)
  • Side Loader
  • Multi - Directional
  • Tele Truck
  • Very Narrow Aisle Truck (aka VNA)

• Q1.5 Was your last training undertaken with

  Current Employer

  Previous Employer(s)

  Self Funded

  Not applicable

• Q1.6 How often have you operated a Forklift truck during the past 12 months?

  Select Every Day At least once per week Once per month No more than 6 times in the last 12 months

  • Every Day
  • At least once per week
  • Once per month
  • No more than 6 times in the last 12 months

• Q1.7 Which types of Forklift truck have you operated at least six times in the past 12 months?

  Select Counterbalance Reach Truck Pivot Steer(aka Bendy) Side Loader Multi - Directional Tele Truck Very Narrow Aisle Truck (aka VNA)

  • Counterbalance
  • Reach Truck
  • Pivot Steer(aka Bendy)
  • Side Loader
  • Multi - Directional
  • Tele Truck
  • Very Narrow Aisle Truck (aka VNA)

• *NOTE – The course you attend is determined on the information you provide in this questionnaire

About You

• Q2.1 ARE YOU TAKING ANY MEDICATION OR HAVE ANY CONDITION THAT PREVENTS YOU FROM OPERATING MACHINERY

  Yes

  No

  N/A

• Q2.2 DO YOU CONSIDER YOURSELF FIT TO DRIVE MACHINERY

  Yes

  No

  N/A

• Q2.3 DOES YOUR NORMAL OR CORRECTED VISION (with glasses or contacts) AT LEAST PASS WHAT IS REQUIRED FOR

  Yes

  No

  N/A

• Q2.4 DRIVING ON PUBLIC ROADS (is your eyesight good enough to see at distance?)

  Yes

  No

  N/A

• Q2.5 IS YOUR HEARING SATISFACTORY WITHIN A WORKING ENVIROMENT (including with aids if needed)

  Yes

  No

  N/A

• Q2.6 ARE YOU DYSLEXIC OR HAVE WORD BLINDNESS OR ANY READING DISORDER

  Yes

  No

  N/A

• Q2.7 DOES ANYTHING PREVENT YOU FROM LOOKING AT HEIGHTS ABOVE 3 METRES

  Yes

  No

  N/A

Training Course Recommendation

• Choose Course Type to Recommend based upon Answers Provided

  Select Conversion Course Novice Course Refresher Course Experienced Course

  • Conversion Course
  • Novice Course
  • Refresher Course
  • Experienced Course

• Select Number of Days required for Training

  1 Day Course

  2 Day Course

  3 Day Course

  4 Day Course

  5 Day Course