A backhoe certification form is a document that is used to certify that a backhoe has been inspected and is in good working order. The form can be used for both personal and commercial purposes. A backhoe certification form should include the date of the inspection, the name of the inspector, and the signature of the owner or operator. The form can be used as proof of inspection if there is an accident or mechanical failure. A backhoe certification form can also be used to prove that a backhoe has been properly maintained.
| 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: ____________________________ |
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License #___________________________________ |
Class:________________ TRINFO class # ____ |
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Section 1 - Classroom Instruction |
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Compl’d ____/____/____ Hrs.______ |
‘ Completed general topics classroom instruction |
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Instructor #1 initials _____________ |
‘ Completed |
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Instructor #2 initials _____________ |
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Section II - Shop Session Instruction |
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Compl’d ____/____/____ Hrs.______ |
‘ Completed PM and general procedures shop instruction |
Instructor #1 initials ______________ |
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‘ Completed |
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Instructor #2 initials ______________ |
‘ Completed vehicle starting and idling shop instruction |
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‘ Completed vehicle parking and |
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Section III - Skills Demonstration |
Refer to the Evaluation Guide for the details of the demonstration |
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Performs a thorough |
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Transports machine over the road to and from job site safely and in operable condition |
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Makes sure that the work site is suitable for backhoe operation |
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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 |
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off the ground |
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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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Returns excavated material to trench without jeopardizing or damaging any aspect of the |
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work |
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9. Readies machine for transport |
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10. Shuts down and secures machine |
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_____ _____ _____ 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 |