Title Page

  • Operators Name

  • Theory Date

  • Practical Evaluation Date/Time

  • Equipment being used for Practical Evaluation

  • Trainer/Evaluator

Pre-Operational Requirements

  • Performs pre-use inspection in accordance with company guidelines?

  • Correctly completes required inspection documentation?

  • Reports deficiencies in accordance with company guidelines?

  • Wears required personal protective equipment (PPE)?

Post Start Up

  • Listens for unusual noises and sounds?

  • Ensures that all safety devices are functioning as required?

  • Ensures all dashboard components are functioning properly?

  • Tests functionality of parking brake?

  • Checks all hydraulic operations including lift, lower, tilt, and side movements?

  • Inspects and tests all foot pedals including the brake, clutch, inching and gas pedals?

  • Uses 3-points of contact when accessing operator's cab?

Pedestrians

  • Slows down and sounds the audible warning devices for pedestrians when required?

  • Establishes eye contact with pedestrians?

  • Does not allow pedestrians to come near while operating the equipment?

  • Is aware of rear end swing and ensures that no pedestrians are in the pathway prior to initiating turns?

  • Never allows pedestrian to cross beneath loads, forks, etc?

  • Does not allow passengers to ride on equipment?

Operational

  • Does the operator look to the rear before reversing?

  • Does the operator perform all actions smoothly and consistently?

  • How did the operator do removing a bundle/object and re-stacking it?

  • Evaluator's comments

  • Trainee/Employee Signature

  • Signature of Practical Evaluator

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.