Zekelman Elevated Work Platform (EWP) Practical Evaluation

• Operator's Name

• Theory Date

  Date

• Practical Evaluation Date/Time

  Date

• Equipment being used for Practical Evaluation

• Trainer/Evaluator

PRE-OPERATIONAL REQUIREMENTS

• Wears required personal protective equipment (PPE) correctly?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Inspects safety harness/lanyard and puts it on correctly?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Completes pre-use inspection checklist correctly?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Notes any defects on checklist and reports verbally to supervision?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

VISUAL CHECKS

• Checks platform/guardrail system/deck extension for damage?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks if manual is present in protected case?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks condition of wheels and tires?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks condition of boom/scissor arms?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks fluid levels/leaks? (engine, battery, hydraulic system)

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks presence & condition of guards, covers and decals?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks the capacity plate information?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks presence & condition of anchorages?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

FUNCTION CHECKS

• Checks instrument readings?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks tilt alarm and warning devices?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks all platform functions (on both control stations)?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks that outriggers/stabilizers are functioning?

  Excellent

  Good

  Okay

  Unacceptable

  N/A

• Notes/Comments

• Checks that emergency/auxiliary controls are functioning?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks that direction and speed controls are functioning?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks brakes and steering?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

BASIC OPERATING PROCEDURES

• Competent and smooth operation of controls?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Travels with platform at safe height?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Travels at safe speed for all conditions?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Keeps clear view of path of travel?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Is aware of all clearances (overhead, side and rear)?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Maintains control at all times?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Operates in approved areas only?

  Excellent

  Good

  Okay

  Unacceptable

  N/A

• Notes/Comments

• Checks all clearances before moving?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Starts all turns in proper position?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Selects best position to elevate?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Keeps a safe distance away from all obstacles/hazards?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Checks below before lowering/retracting?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Parks unit safely and correctly?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

GENERAL SAFETY

• Checks intended path of travel and all clearances before each task?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Slows down, yields to, sounds audible warning device and establishes eye contact with pedestrians?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Does not allow pedestrians to come near or underneath equipment?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Keeps body and hands inside the guardrail system at all times?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Competent with charging procedures?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

• Uses 3-points of contact when mounting/dismounting the platform?

  Excellent

  Good

  Okay

  Unacceptable

• Notes/Comments

SIGN-OFF

• Evaluator's Overall Comments/Summary

• Operator's Signature

  Sign

• Evaluator's Signature

  Sign