Title Page
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Operators name
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Prepared by
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Date
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Location
Untitled page
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Performs pre-shift inspection?
- Excellent
- Good
- Fair
- Poor
-
Demonstrates knowledge of equipment
- Excellent
- Good
- Fair
- Poor
-
Correctly completes required inspection report?
- Excellent
- Good
- Fair
- Poor
-
Reports deficiencies to supervisor?
- Excellent
- Good
- Fair
- Poor
-
Wearing proper (PPE)?
- Excellent
- Good
- Fair
- Poor
-
Ensures all safety devices function properly - E-stop, warning lights, horn, etc.
- Excellent
- Good
- Fair
- Poor
-
Ensures all dashboard components function properly
- Excellent
- Good
- Fair
- Poor
-
Ensures parking brake works properly
- Excellent
- Good
- Fair
- Poor
-
Checks all moving parts for proper travel ( lift, lower, side movements, steering and drive operations)
- Excellent
- Good
- Fair
- Poor
-
Test all foot pedals
- Excellent
- Good
- Fair
- Poor
-
3 points of contact entering and exiting cab
- Excellent
- Good
- Fair
- Poor
-
Slows down for pedestrians and sounds horn
- Excellent
- Good
- Fair
- Poor
-
Establishes eye contact with pedestrians
- Excellent
- Good
- Fair
- Poor
-
Does not allow pedestrians to come near equipment while operating
- Excellent
- Good
- Fair
- Poor
-
Aware of equipment overhang when moving and turning equipment
- Excellent
- Good
- Fair
- Poor
-
Never allows pedestrians to cross under load
- Excellent
- Good
- Fair
- Poor
-
Implements the use of a spotter to ensure all clear around equipment before and during movement
- Excellent
- Good
- Fair
- Poor
-
Performs all functions smoothly and consistently
- Excellent
- Good
- Fair
- Poor
-
Implements the use of hands free tools while placing dunnage under module and while holding lift chains in position when lifting in commenced.
- Excellent
- Good
- Fair
- Poor
-
Both operator and spotters are aware and avoid the pinch point between Combi-Lift and module.
- Excellent
- Good
- Fair
- Poor
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Never leaves a load unattended
- Excellent
- Good
- Fair
- Poor
-
Doesn't work or allow anyone else to work under an elevated module without the use of stands in place
- Excellent
- Good
- Fair
- Poor
-
How did operator do lifting, moving and setting unit?
- Excellent
- Good
- Fair
- Poor
-
Correctly stores remote
- Excellent
- Good
- Fair
- Poor
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Proper shut down of equipment
- Excellent
- Good
- Fair
- Poor
Untitled page
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Employee Signature
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Practical evaluator signature