Title Page
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SCISSOR LIFT OPERATOR EVALUATION
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Jobsite Location:
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Make and Model: (take photo of machine)
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Date of Evaluation:
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Superintendent (s):
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Operator Name:
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Years of Experience:
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Reason for Evaluation:
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Evaluated By:
Evaluation
BEFORE STARTING ENGINE
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Daily Pre-Use Inspection Completed?
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Perform assessment walk of work area, check of area of operation and surrounding work area for potential hazards
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Maximum Weight Observed
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Control panel reviewed
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Ground Control Functions Reviewed
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Demonstrate Use of Safety Arm
FALL PROTECTION VERIFICATION
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Demonstrate proper inspection of harness & retractable
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Hand rails are fall protection on scissor lifts unless feet leave floor of working platform.
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Anchorage points identified (structural w/scissor lift)
START UP & MANEUVERING
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Operator turns body and head in direction of travel for best visibility.
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Looking around for surface problems, avoid those problems
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Adjust speed to conditions of work area
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Raise and lower platform
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Extend and retract slide out platform
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Turn unit slowly and at a proper speed for conditions
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Maneuver around obstacles – similar to those that will be encountered in the work area.
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Emergency Lowering Control Located and Practiced
PARKING
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Engine or electrical stop switch is in the off position
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Assure machine is lowered all the way and is stopped on as level surface as possible
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Maintains three points of contact when dismounting. Does not jump off of machine.
EVALUATION
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Based on my evaluation, the operator has completed the evaluation and is qualified to operate the equipment
