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Circle a “Y” if the employee passes or an “N” if the employee does not perform the task properly.
Re-evaluation: Any circled “N” requires that the employee be re-instructed in the areas of concern and evaluated again if needed.
Comments box: This re-evaluation shall be indicated as being performed in the comments box. Only then can a “Pass” be achieved.
Fall protection: If fall protection is used the user must be trained in the use of fall protection.
Sections: Visual checks, operator checks and basic operation.
Return: Return the completed form to the Safety Department.
| Question | Answer |
|---|---|
| Form Name | Equipment Operator Evaluation Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Where to send | The Safety Department |
| Other names | Equipment Operator Evaluation Form, operator evaluation form, Boom Lift operator evaluation, Scissor Lift operator evaluation |
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