Information
-
Conducted on
-
Prepared by
-
Employee being evaluated
-
Location
-
EQUIPMENT INFORMATION
PRE-USE INSPECTION
-
Follow the Operator's Daily Checklist
-
Look for damage
-
Document all findings on checklist
SURVEY/INSPECT WORKSITE
-
Verify appropriate wind and weather conditions
-
Checks for overhead obstructions and electrical hazards
-
Checks for ground level obstructions and debris
-
Checks for bystanders
-
Checks for any other unsafe conditions
LOWER CONTROL STATION TEST
-
Completed a proper function test to determine any malfunctions
SAFE ACCESS TO PLATFORM
-
Face the machine and maintains 3 points of contact while entering
USE OF FALL PROTECTION EQUIPMENT
-
Properly put on all correct fall protection
-
Promptly and properly tied off to equipment upon platform access
PLATFORM CONTROL STATION TEST
-
Completed proper function test to determine any malfunctions
SAFE TRAVEL: DRIVE AND CREEP "INCH: FORWARD AND REVERSE"
-
Move approximately 10 feet in a driving mode. Creep approximately 5 feet. Verify unit balance and stability.
TURN LIFT 360 DEGREES IN EACH DIRECTION
-
Minimum disturbance of lift platform. Verify unit balance and stability.
ELEVATE PLATFORM TO WORKING HEIGHT
-
Safe operation including but not limited to: Check to clear nearby personnel, overhead obstructions and electrical hazards
SHUT DOWN MACHINE USING EMERGENCY STOP FUNCTION
-
Locate and use emergency stop function
PARK AND SHUTDOWN MACHINE
-
Park in safe and stable area
-
Properly shut off operator's panel
SAFE DISMOUNT FROM LIFT
-
Face the machine and maintains 3 points of contact while exiting
FINAL SHUTDOWN OF MACHINE
-
Locate and activate "Dead Man or Kill Switch" to shut lift down completely
-
Promptly and properly untie from equipment when exiting platform
-
Based on my evaluation, the operator has ______________________ completed the evaluations and hands-on training.
-
Evaluator Signature
-
Operator Signature
