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  • Forklift Operator Evaluation Form Compress Dikonversi

    Uploaded by

    Dondy Zobitana
    40 views31 pages
    This forklift operator evaluation form contains instructions for evaluating an operator's proficiency using a forklift. The form lists operator behaviors that will be rated during a field evaluation session, including pre-use inspection, picking up and transporting loads, putting loads down, parking, and fueling/recharging. The evaluator will rate the operator's performance on each behavior as good, fair, or poor and provide any relevant comments. Upon completion, the evaluator will determine if the operator has passed the evaluation and is qualified to operate the forklift.

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    This forklift operator evaluation form contains instructions for evaluating an operator's proficiency using a forklift. The form lists operator behaviors that will be rated during a field evaluation session, including pre-use inspection, picking up and transporting loads, putting loads down, parking, and fueling/recharging. The evaluator will rate the operator's performance on each behavior as good, fair, or poor and provide any relevant comments. Upon completion, the evaluator will determine if the operator has passed the evaluation and is qualified to operate the forklift.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    40 views31 pages

    Forklift Operator Evaluation Form Compress Dikonversi

    Uploaded by

    Dondy Zobitana
    This forklift operator evaluation form contains instructions for evaluating an operator's proficiency using a forklift. The form lists operator behaviors that will be rated during a field evaluation session, including pre-use inspection, picking up and transporting loads, putting loads down, parking, and fueling/recharging. The evaluator will rate the operator's performance on each behavior as good, fair, or poor and provide any relevant comments. Upon completion, the evaluator will determine if the operator has passed the evaluation and is qualified to operate the forklift.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 31

    Forklift Operator Evaluation Form

    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Page 1 of 31
    Putting Down A Load COMMENTS
    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:

    Page 2 of 31
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Page 3 of 31
    Putting Down A Load COMMENTS
    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:

    Page 4 of 31
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Page 5 of 31
    Putting Down A Load COMMENTS
    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:

    Page 6 of 31
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.

    Page 7 of 31
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 8 of 31
    Evaluator Signature: Operator Signature:
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    Page 9 of 31
    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 10 of
    Evaluator Signature: Operator Signature:
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A


    Page 11 of 31
    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 12 of
    Evaluator Signature: Operator Signature:

    Forklift Operator Evaluation Form


    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A


    Page 13 of 31
    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 14 of
    Evaluator Signature: Operator Signature:
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A


    Page 15 of 31
    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 16 of
    Evaluator Signature: Operator Signature:
    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A


    Page 17 of 31
    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Page 18 of
    Evaluator Signature: Operator Signature:

    Forklift Operator Evaluation Form


    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    Page 19 of 31
    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the follo

    Page 20 of 31
    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:


    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    Page 21 of 31
    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the follo

    Page 22 of
    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:


    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    Page 23 of 31
    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the follo

    Page 24 of
    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:

    Forklift Operator Evaluation Form


    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    Page 25 of
    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Page 26 of
    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the f

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:


    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    Page 27 of
    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Page 28 of
    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the f

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:


    Forklift Operator Evaluation Form
    Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
    ensure that operators are continuing to operate forklifts properly.

    Operator Name Evaluator Name

    Date of Evaluation Equipment Operated

    OPERATOR BEHAVIORS RATING COMMENTS


    Pre-use Insepection
    1. Follow Operator’s Daily Checklist. GOOD FAIR POOR N/A

    2. Look for Damage. GOOD FAIR POOR N/A

    3. Document all findings on the checklist GOOD FAIR POOR N/A

    Picking Up The Load


    1. Square up on the center of the load. GOOD FAIR POOR N/A

    2. Stop with the fork tips about 1 foot from the load. GOOD FAIR POOR N/A

    3. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    4. Level the forks; then slowly drive forward until GOOD FAIR POOR N/A
    the load contacts the carriage.
    5. Lift the load carefully and smoothly until it is GOOD FAIR POOR N/A
    clear.

    6. Tilt the mast back slightly to stabilize the load. GOOD FAIR POOR N/A

    7. Look over both shoulders. GOOD FAIR POOR N/A

    8. After out and stopped, lower the load to travel GOOD FAIR POOR N/A
    height.
    Traveling
    1. Do not raise or lower the load and forks while GOOD FAIR POOR N/A
    traveling.

    Page 29 of
    2. Maintain a safe speed. GOOD FAIR POOR N/A

    3. Observe all traffic rules, warning signs, floor load GOOD FAIR POOR N/A
    limits and overhead clearances.
    4. Keep arms and legs inside the forklift. GOOD FAIR POOR N/A

    5. Follow other vehicles at safe distance. GOOD FAIR POOR N/A

    6. Slow down when cornering. GOOD FAIR POOR N/A

    7. Use the horn to alert others. GOOD FAIR POOR N/A

    8. Travel with the load facing uphill while on a ramp GOOD FAIR POOR N/A
    or incline.
    9. Stop smoothly. GOOD FAIR POOR N/A

    Putting Down A Load COMMENTS


    1. Make sure there is sufficient clearance for the GOOD FAIR POOR N/A
    load.

    2. Clear personnel from the area near the load. GOOD FAIR POOR N/A

    3. Square up to the location; then stop about 1 foot GOOD FAIR POOR N/A
    away.
    4. Raise the load to placement level. GOOD FAIR POOR N/A

    5. Move slowly forward. GOOD FAIR POOR N/A

    6. If the load is on a pallet, lower it into position and GOOD FAIR POOR N/A
    lower the forks further.
    7. Look over both shoulders before backing out. GOOD FAIR POOR N/A

    8. Back straight out until the forks have cleared. GOOD FAIR POOR N/A

    9. Lower the forks to traveling position. GOOD FAIR POOR N/A

    Parking
    1. Fully lower the forks. GOOD FAIR POOR N/A

    2. Neutralize the controls. GOOD FAIR POOR N/A

    3. Set the brakes. GOOD FAIR POOR N/A

    4. Turn off the power. GOOD FAIR POOR N/A

    5. If parked on an incline, block the wheels. GOOD FAIR POOR N/A

    6. Park only in authorized areas. GOOD FAIR POOR N/A

    Fueling And Battery Recharging


    1. Engine off. GOOD FAIR POOR N/A

    2. Fire extinguisher nearby. GOOD FAIR POOR N/A

    3. Proper personal protective equipment worn. GOOD FAIR POOR N/A

    4. Safe fueling and battery recharging procedures GOOD FAIR POOR N/A
    followed.
    5. Spills cleaned up immediately. GOOD FAIR POOR N/A

    Page 30 of
    Based on my evaluation, the operator has successfully completed the evaluation and is qualified to operate the fo

    Based on my evaluation, the operator has not demonstrated competence in operating the following equipment:

    Evaluator Signature: Operator Signature:

    Page 31 of

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