SFG Industrial LLC, Powered Industrial Truck Operator Safety Evaluation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Instructor / Evaluator

• Location
  Address

Assessor Competancy

• Is the evaluator trained and does he/she have a full understanding of the vehicles that they are to assess?

  Yes

  No

  N/A

Vehicle Type

• Type of forklift equipment?

  Select Stand up forklift Sit down counter balance Rough terrain extendable boom

  • Stand up forklift
  • Sit down counter balance
  • Rough terrain extendable boom

• Add media

  Media

Operator Details

• Has operator completed classroom portion of training?

  Yes

  No

  N/A

• Does the operator have a valid certificate of training that has been passed or refreshed within the last three years?

  Yes

  No

  N/A

• Date classroom portion of training completed?

  Date

Daily Safety Inspection

• The operator completed the safety pre-shift safety inspection correctly?

  Yes

  No

  N/A

• The operator understands the correct fault reporting procedures?

  Yes

  No

  N/A

• The operator fully understands the capacity information plate?

  Yes

  No

  N/A

Operator Safety & Observation

• The operator mounts / dismounts correctly?

  Yes

  No

  N/A

• Uses the seatbelt correctly?

  Yes

  No

  N/A

• Keeps body parts within the confines of the vehicle?

  Yes

  No

  N/A

• Operator looks in the direction of travel?

  Yes

  No

  N/A

• Operator slowed down at intersections?

  Yes

  No

  N/A

• Operator sounded horn at intersections?

  Yes

  No

  N/A

• Operator yielded to pedestrians?

  Yes

  No

  N/A

• Follows the correct procedures for an "unattended" vehicle?

  Yes

  No

  N/A

• Operator demonstrates proper operation on ramps and other sloped surfaces that would affect stability?

  Yes

  No

  N/A

• Operator has good all around safety awareness?

  Yes

  No

  N/A

Steering & Operating Controls

• Starts and stops smoothly?

  Yes

  No

  N/A

• Gave proper signals when turning?

  Yes

  No

  N/A

• Turned corner correctly (aware of rear end swing)?

  Yes

  No

  N/A

• Releases the parking brake prior to moving?

  Yes

  No

  N/A

• Rough use of hydraulic controls?

  Yes

  No

  N/A

• Shows familiarity with truck controls?

  Yes

  No

  N/A

Competency In Load Capacity

• Operator matches load with the truck's capacity?

  Yes

  No

  N/A

• Operator checks the load for stability?

  Yes

  No

  N/A

Maneuvering & Transportation

• Forks at correct height when traveling empty?

  Yes

  No

  N/A

• Traveled with load at proper height?

  Yes

  No

  N/A

• Forks at correct height when parked?

  Yes

  No

  N/A

• When operating in reverse, looking in the direction of travel?

  Yes

  No

  N/A

• Operates at a speed consistent with the type of load and working conditions?

  Yes

  No

  N/A

• Operator performs safe maneuvering with the lift truck and load?

  Yes

  No

  N/A

Stacking & de-stacking

• Raised/lowered load smoothly?

  Yes

  No

  N/A

• Operator applies the park brake when operating the hydraulics?

  Yes

  No

  N/A

• Operator applies neutral when operating the hydraulics?

  Yes

  No

  N/A

• Fork arms centered under the load?

  Yes

  No

  N/A

• Fork arms not rubbing (entry / withdrawal)?

  Yes

  No

  N/A

• Fork tips enter center of pallet opening?

  Yes

  No

  N/A

• Forks / load level?

  Yes

  No

  N/A

• Load correctly stacked?

  Yes

  No

  N/A

• Fork arms fully inserted?

  Yes

  No

  N/A

Parking

• The operator correctly applies the park brake?

  Yes

  No

  N/A

• The operator sets the direction lever to the neutral position?

  Yes

  No

  N/A

• The operator correctly applies forward tilt?

  Yes

  No

  N/A

• The operator correctly lowers the forks?

  Yes

  No

  N/A

• The steering wheels are in the straight position?

  Yes

  No

  N/A

• The operator switches off and removes the key?

  Yes

  No

  N/A

Assessment Recommendations & Evaluations

• Assessor's evaluation of operator safety?

  Excellent

  Good

  Satisfactory

  Re-training is advised

• Comments

• Operator passed evaluation?

  Yes

  No

  N/A

Signatures

• Date and time of assessment

  Date

• Operator signature

  Sign

• Operator / Printed Name

• Picture of Operator

  Media

• Evaluator signature

  Sign