Section 1: Plant Vehicle
1. Type of equipment?
Section 2: Operator Details
1. Has the operator a valid certificate of training that has been passed or refreshed within the last three years?
Yes
No
N/A
2. Date of test or refresher course?
3. Has the operator an up to date authorisation to operate, signed and renewable annually?
Yes
No
N/A
4. Date of signed authorization operate the plant vehicle
Section 3: Daily Safety Inspection
1. The operator completes the safety Pre-shift safety inspection correctly
Yes
No
N/A
2. The operator fully understands the capacity information plate?
Yes
No
N/A
3. The operator understands the correct fault reporting procedures?
Yes
No
N/A
Section 4: Operator Safety & Observation
1. Mounts / dismounts correctly
Yes
No
N/A
2. Uses the seat belt correctly
Yes
No
N/A
3. Keeps body parts within the confines of the vehicle
Yes
No
N/A
4. Looks in the direction of travel
Yes
No
N/A
5. Use the horn appropriately
Yes
No
N/A
6. Follows the correct procedures for an "unattended" vehicle?
Yes
No
N/A
7. Was good all round safety observation
Yes
No
N/A
Section 5: Steering & Operating Controls
1. Starts and stops smoothly
Yes
No
N/A
2. Uses assistor correctly
Yes
No
N/A
3. Travels unintentionally in the wrong direction
Yes
No
N/A
4. Brakes harshly / erratically
Yes
No
N/A
5. Releases the parking brake prior to moving off
Yes
No
N/A
6. Rides the foot brake
Yes
No
N/A
7. Operates the hydraulic controls when the lift truck is in motion
Yes
No
N/A
8. Operates and understands the controls
Yes
No
N/A
Section 6: Competency In Load Capacity
1. Matches load with the truck's capacity
Yes
No
N/A
2. Checks the load for stability
Yes
No
N/A
Section 7: Maneuvering & Transportation
1. Forks to high when traveling
Yes
No
N/A
2. Forks to low when traveling
Yes
No
N/A
3. Operates in reverse, looking in the direction of travel to the correct ratio
Yes
No
N/A
4. Operates at a speed consistent with the type of load and working conditions?
Yes
No
N/A
5. Performs safe maneuvering with the lift truck and load
Yes
No
N/A
Section 8: Stacking & de-stacking
1. Applies the park brake when operating the hydraulics
Yes
No
N/A
2. Applies neutral when operating the hydraulics
Yes
No
N/A
3. Forks arm central under the load
Yes
No
N/A
4. Fork arms not rubbing (entry / withdrawal)
Yes
No
N/A
5. Fork tips touch the stack / load
Yes
No
N/A
6. Forks / load not level
Yes
No
N/A
7. Stacked load correctly
Yes
No
N/A
8. Fork arms not fully inserted (undercut)
Yes
No
N/A
Section 9: Parking
1. Correctly applies the park brake
Pass
Fail
N/A
2. Sets the direction lever to the neutral position
Pass
Fail
N/A
3. Correctly apples forward tilt
Pass
Fail
N/A
4. Correctly lowers the fork arms
Pass
Fail
N/A
5. Maneuvers wheels are in the straight position
Pass
Fail
N/A
6. Switches off and removes the key
Pass
Fail
N/A
Section 10: Assessment Recommendations & Evaluations
1. Overall Evalution of the Operator
Ok
Needs Repair
N/A
Repaired
2. Recommendations