Get TAM Workers Comp Forklift Operator Evaluation form

Forklift Operator Evaluation Form Company Date Area Shift Model Unit Operator Name Evaluator Name 1 Inspection a Mast mastguard and forks checked. b Wheels and tires checked. c Engine fluid levels checked. d Fanbelts checked. e Engine cover latches secured. f Rollover protection checked. g Seatbelt checked. h Backup alarm checked. i Controls checked. j Labels markings and load charts checked. k Steering checked. l Braking checked. m If propane fuel connections and mounting bracket checked. n Conducted general check for leaks. 2 Startup a Inspection performed and documented* b Company required PPE worn* d Machine out of gear. e Parking brake engaged* g Lift truck allowed to warm-up* h Forks lifted to minimum distance needed for clearance while traveling. i Low gear engaged* k Observed for materials vehicles and pedestrians before movement. 3 Travel a Kept forks low. b Continued to wear seatbelt. c Maintained reasonable speed for conditions. d Successfully shifted gears. e Yielded to pedestrians. f Honked at blind intersections and areas with poor visibility. g Forks kept upramp when going up or down ramps. h Avoided running or objects. i Crossed railroad tracks at an angle. j Demonstrated awareness of overhead hazards. 4 Trailers a b c d e Verified the floor loading capacity. Properly positioned dock plate. Inspected floor. 5 Positioning Load a Load within capacity. b Load balanced* c Load secured* d Center of gravity positioned close to the mast. e Tilted load rearwards. f Used ground guide or drove backwards when forward visibility obscured* 6 High Stacking a Operator aware of rack capacity or stacking limitations. b Withdrew and lowered load to the ground immediately upon clearing rack. c Elevated load only after in close proximity to rack. d Load kept tilted rearwards during lift. e Load tilted forward after positioned over rack. 7 Shutdown a Forks lowered to the floor. c Shifted into neutral* d Turned engine off if operator is further than 25 feet away. I hereby certify that I have conducted an evaluation of this employee s ability to safely operate a lift truck and I have determined that their performance is satisfactory. 2 Startup a Inspection performed and documented* b Company required PPE worn* d Machine out of gear. e Parking brake engaged* g Lift truck allowed to warm-up* h Forks lifted to minimum distance needed for clearance while traveling. e Parking brake engaged* g Lift truck allowed to warm-up* h Forks lifted to minimum distance needed for clearance while traveling. i Low gear engaged* k Observed for materials vehicles and pedestrians before movement. 3 Travel a Kept forks low. i Low gear engaged* k Observed for materials vehicles and pedestrians before movement. 3 Travel a Kept forks low. b Continued to wear seatbelt. c Maintained reasonable speed for conditions. d Successfully shifted gears. b Continued to wear seatbelt. c Maintained reasonable speed for conditions. d Successfully shifted gears. e Yielded to pedestrians. f Honked at blind intersections and areas with poor visibility. g Forks kept upramp when going up or down ramps. .