In the realm of occupational safety and operational proficiency, the Backhoe Certification Form stands as a pivotal document designed to ensure that individuals operating this heavy equipment are fully trained, evaluated, and deemed competent. This form encompasses a comprehensive structure that includes essential employee information like name, title, supervisor, work location, and license details, providing a clear identification framework for both the operator and the certifying authority. The certification process is meticulously divided into three main sections: Classroom Instruction, Shop Session Instruction, and Skills Demonstration, each aimed at covering different facets of backhoe operation. Initial sections focus on theoretical knowledge and practical procedures, including pre-operation inspection and maintenance, while the final section gauges the operator’s ability to safely and effectively execute tasks through a series of evaluated activities. The form details performance criteria for skills such as conducting a thorough pre-operational inspection, safely transporting the machine, ensuring the work site’s suitability, and proficiently handling the backhoe during operation, among others. Completion dates, instructor initials, and an evaluation committee's final assessment further enrich the document, ensuring a rigorous certification process. The Backhoe Certification Form not only serves as a testament to an individual’s capabilities but also as a crucial tool in upholding safety standards and operational excellence in environments where backhoes are essential.
| Question | Answer |
|---|---|
| Form Name | Backhoe Certification Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | initials inspection classroom, backhoe operable certified, backhoe operable certification, 3 backhoe certification |
•BACKHOE CERTIFICATION FORM
Employee Information
HMW 3 (11/96)
E11
Name:______________________________________ Title: _____________________________________
Supervisor: _________________________________ |
Work Location: ____________________________ |
|
License #___________________________________ |
Class:________________ TRINFO class # ____ |
|
|
|
|
|
|
|
Section 1 - Classroom Instruction |
|
Compl’d ____/____/____ Hrs.______ |
‘ Completed general topics classroom instruction |
|
Instructor #1 initials _____________ |
‘ Completed |
|
Instructor #2 initials _____________ |
|
|
|
Section II - Shop Session Instruction |
|
Compl’d ____/____/____ Hrs.______ |
‘ Completed PM and general procedures shop instruction |
Instructor #1 initials ______________ |
|
‘ Completed |
|
Instructor #2 initials ______________ |
‘ Completed vehicle starting and idling shop instruction |
|
|
‘ Completed vehicle parking and |
|
|
Section III - Skills Demonstration |
Refer to the Evaluation Guide for the details of the demonstration |
||||||
|
|
|
|
|
|
|
|
P |
F |
P |
F |
P F |
|
|
|
‘ |
‘ |
‘ |
‘ |
‘ ‘ |
1. |
Performs a thorough |
|
‘ |
‘ |
‘ |
‘ |
‘ ‘ |
2. |
Transports machine over the road to and from job site safely and in operable condition |
|
‘ |
‘ |
‘ |
‘ |
‘ ‘ |
3. |
Makes sure that the work site is suitable for backhoe operation |
|
‘ |
‘ |
‘ |
‘ |
‘ ‘ |
4. |
Positions backhoe in line with work and as close to level as possible |
|
‘ ‘ |
‘ ‘ |
‘ ‘ |
5. Stabilizes machine using the side stabilizers and front bucket without raising machine tires |
||||
|
|
|
|
|
off the ground |
|
|
‘ ‘ |
‘ ‘ |
‘ ‘ |
6. |
Manipulates the boom and bucket in a smooth and continuous motion |
|||
‘ ‘ |
‘ ‘ |
‘ ‘ |
7. Excavates a marked trench by coordinating the backhoe’s main boom, pull and bucket |
||||
‘ ‘ |
‘ ‘ |
‘ ‘ |
8. |
Returns excavated material to trench without jeopardizing or damaging any aspect of the |
|||
|
|
|
|
|
work |
|
|
‘ ‘ |
‘ ‘ |
‘ ‘ |
9. Readies machine for transport |
||||
‘ ‘ |
‘ ‘ |
‘ ‘ |
10. Shuts down and secures machine |
||||
_____ _____ _____ Date completed:___________________ Vehicle Make: __________
Evaluation Committee Initials Time spent w/Operator:________________ ID #:___________________
Certification |
Attempt # ‘ 1 ‘ 2 |
‘ 3 |
‘Check if any variations were made in the evaluation and describe on reverse
‘Employee certified for operation of Backhoe
‘Employee not certified - needs improvement on: ________________________________________
_____________________________________ ____________________________________
Certifier Signature |
Employee Signature |