Backhoe Certification Form PDF Details

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.

QuestionAnswer
Form NameBackhoe Certification Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesinitials inspection classroom, backhoe operable certified, backhoe operable certification, 3 backhoe certification

Form Preview Example

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 pre-op inspection classroom instruction

 

Instructor #2 initials _____________

 

 

 

Section II - Shop Session Instruction

 

Compl’d ____/____/____ Hrs.______

Completed PM and general procedures shop instruction

Instructor #1 initials ______________

Completed pre-op inspection shop instruction

 

Instructor #2 initials ______________

Completed vehicle starting and idling shop instruction

 

 

Completed vehicle parking and shut-down instruction

 

 

Section III - Skills Demonstration

Refer to the Evaluation Guide for the details of the demonstration

 

 

 

 

 

 

 

 

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1.

Performs a thorough pre-op inspection and daily/weekly PM, as needed

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2.

Transports machine over the road to and from job site safely and in operable condition

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3.

Makes sure that the work site is suitable for backhoe operation

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4.

Positions backhoe in line with work and as close to level as possible

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5. Stabilizes machine using the side stabilizers and front bucket without raising machine tires

 

 

 

 

 

off the ground

 

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6.

Manipulates the boom and bucket in a smooth and continuous motion

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7. Excavates a marked trench by coordinating the backhoe’s main boom, pull and bucket

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8.

Returns excavated material to trench without jeopardizing or damaging any aspect of the

 

 

 

 

 

work

 

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9. Readies machine for transport

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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