Title Page
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Operators Name
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Theory Date
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Practical Evaluation Date/Time
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Equipment being used for Practical Evaluation
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Trainer/Evaluator
Pre-Operational Requirements
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Performs pre-use inspection in accordance with company guidelines?
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Correctly completes required inspection documentation?
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Reports deficiencies in accordance with company guidelines?
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Wears required personal protective equipment (PPE)?
Post Start Up
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Listens for unusual noises and sounds?
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Ensures that all safety devices are functioning as required?
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Ensures all dashboard components are functioning properly?
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Tests functionality of parking brake?
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Checks all hydraulic operations including lift, lower, tilt, and side movements?
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Inspects and tests all foot pedals including the brake, clutch, inching and gas pedals?
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Uses 3-points of contact when accessing operator's cab?
Pedestrians
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Slows down and sounds the audible warning devices for pedestrians when required?
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Establishes eye contact with pedestrians?
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Does not allow pedestrians to come near while operating the equipment?
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Is aware of rear end swing and ensures that no pedestrians are in the pathway prior to initiating turns?
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Never allows pedestrian to cross beneath loads, forks, etc?
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Does not allow passengers to ride on equipment?
Operational
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Does the operator look to the rear before reversing?
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Does the operator perform all actions smoothly and consistently?
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How did the operator do removing a bundle/object and re-stacking it?
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Evaluator's comments
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Trainee/Employee Signature
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Signature of Practical Evaluator
