Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Instructions: Please print clearly, and complete each blank. Mark each task as a pass or fail. If the item does not apply, mark the item as NA. Once completed, submit this form to your HR/Safety Coordinator
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The skills test is to be conducted for each employee authorized to drive a forklift at your facility at new hire and then again every 3 years or whenever behavior indicates the need including an accident, disciplinary action, employee complaint, or observation of improper skills or behavior. The test is to be administered by an individual who is experience and qualified in safe operation of a forklift
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Was this test completed on a mobile device or a computer? (If test was written on the floor while testing and then entered later on a computer, please attach a photo of written test).
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Truck #/Model
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Name of Operator
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Name of Evaluator
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Date
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1. Conducted preinspection checklist or verified it was completed
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2. Gave proper signals when turning
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3. Slowed down at intersections
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4. Sounded horn at intersection
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5. Reviewed speed limit policy is not to exceed 5 mph or speed of walking
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6. Kept a clear view of direction of travel
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7. Turned corners correctly – was aware of rear end swing
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8. Yielded to pedestrians
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9. Drove under control and within proper traffic aisles
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10. Load balanced properly including when removing reels from pallet
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11. Forks under load all the way
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12. Traveled with load at proper height
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13. Lowered load smoothly/slowly
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14. Stops smoothly/completely
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15. Demonstrated how to load/unload warehouse rack
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16. Demonstrated how to upright a reel
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17. Demonstrated how to approach a take up and pay off
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18. Demonstrated how to stack reels with flanges safely aligned
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19. Demonstrated how to use bridge plates/dock plates and ramps
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20. Wore seat belt and ppe (hard hat, safety glasses, gloves, ear protection)
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21. Did place loads within marked areas
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22. Did drive backward when required
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23. Understands how to check load weights
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24.Demonstrated parking safety - forks on the floor, controls neutralized, brake set, and power off
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25. Demonstrated how to change the propane tank on the forklift.
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26. Reviewed instructions for submitting a repair request.
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27. Reviewed SOP to chalk wheels and activate dock lighting system.
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28. Reviewed SOP for Loading/Unloading trailers, if no dock lighting
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Overall Performance (circle one) Mark form as complete below
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Evaluator signature
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Operator signature
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Is this form complete
