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Forklift Operator Evaluation Form
Location
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Employee Name:
Employee #
Trainer and/or Evaluator Name:
Is this a New Hire or Temporary/Periodic employee?
New Hire
Temp/Periodic
OPERATOR BEHAVIORS
Certification card in operator's possession or classroom training completed?
Yes
No
N/A
OPERATOR BEHAVIORS
Visually checked for damage?
Yes
No
N/A
OPERATOR BEHAVIORS
Checked proper fun
ctioning of wheels, horn, battery controller, brakes, steering mechanism and lift systems?
Yes
No
N/A
OPERATOR BEHAVIORS
Report Safety Exceptions?
Yes
No
N/A
FORKLIFT OPERATION
Positioned body safely inside running lines of forklift (feet firmly on riding platform with hands on controls?
Yes
No
N/A
FORKLIFT OPERATION
Yielded right-of-way whenever necessary to avoid hazardous incidents?
Yes
No
N/A
FORKLIFT OPERATION
Maintained a safe distance from people and other equipment?
Yes
No
N/A
FORKLIFT OPERATION
Kept forklift mast clear of overhead objects such as doorways, beams, light fixtures, pipes, sprinklers, etc.?
Yes
No
N/A
FORKLIFT OPERATION
Backed forklift (blades trailing)?
Yes
No
N/A
FORKLIFT OPERATION
When empty, blades were positioned as close to the ground as possible (moving or parked)?
Yes
No
N/A
FORKLIFT OPERATION
Parked forklift in safe manner, not creating a hazard in congested areas or with blades creating hazard?
Yes
No
N/A
FORKLIFT OPERATION
Maintained a minimum safe distance of 3 truck lengths from forklifts equipped with seat belts by manufacturer?
Yes
No
N/A
FORKLIFT OPERATION
Forklift operator had seatbelt fastened (on forklifts equipped with seatbelts)?
Yes
No
N/A
HANDLING LOADS
Did operator attempt to move any load that exceeded the forklift's safe handling capacity?
Yes
No
N/A
HANDLING LOADS
Traveled with blades trailing the forklift, with and without loads?
Yes
No
N/A
HANDLING LOADS
Tilted back blades far enough that pallet and product were at safe angles?
Yes
No
N/A
HANDLING LOADS
Constantly maintained a 10-foot safety perimeter around forklift anytime loads were elevated or lowered down?
Yes
No
N/A
HANDLING LOADS
Kept all body parts within the running lines of equipment?
Yes
No
N/A
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