SECTION 1 – Information
Operator Name:	Evaluation:	Pass	Fail
Type of Forklift/s:	Class I – Electric Motor, Sit-down Rider, Counter- Balanced Trucks (Solid and Pneumatic Tires)
Class II – Electric Motor Narrow Aisle Truck (Solid Tires)
Class III – Electric Motor Hand Truck or Hand/Rider Truck ( Solid Tires)
Class IV – Internal Combustion Engine Truck (Solid Tires)
Class V - Internal Combustion Engine Truck (Pneumatic Tires)
Class VI – Electric and Internal Combustion Engine Tractors (Solid and Pneumatic Tires)
Class VII – Rough Terrain Forklift Truck (Pneumatic Tires)
Date of Evaluation:
Location:
SECTION 2 – Skills Evaluation
Good Execution	Needs Improvement	Description of Skill
Conducts a thorough pre-use inspection: Knows how to perform each inspection point Explains how to report vehicle deficiencies and needed repairs
Demonstrates proper use of all controls: parking brake, attachments, clutch, steering mechanism, inching control and fork tilt and lift
Shows/explains how to refuel the vehicle properly: Gasoline/diesel refueling Exchange propane tank Charge electric batteries Required personal protective equipment (PPE) Able to cite required safety guidelines
Follows proper procedures for an “unattended” PIT: Lowers the forks Sets the brakes Place controls in neutral Shuts off the engine
Demonstrates competency in basic maneuvering skills: Starts and stops smoothly Scans effectively Maintains proper speed Steers smoothly Uses horn when appropriate Turns slowly
Maneuvers in tight spaces with attention to rear swing.
Demonstrates competency in picking up/setting down a load: Matches load with truck’s capacity Approaches straight with the forks in traveling position and squares up on the center of the load Stops about a foot away, levels the forks and slowly drives forward until the load is resting against the backrest Lifts the load high enough to clear whatever is under it Carefully tilts the mast back to stabilize the load Adjusts load as needed to compensate for stability issues
Demonstrates competency in stacking a load: Approaches the load squarely Stacks straight, squarely and not too high Deposits load safely Does not move until forks are lowered
Demonstrates competency in loading/unloading trailer/railcar/other (if applicable): Checks the dock plate Checks the condition of the floor Checks the trailer chocks, jack stands and brakes
Follows proper procedures for mounting, dismounting and engaging the vehicle: Uses three point stance Puts on seat belt Does not jump from vehicle Applies brake Shifts to neutral
SECTION 3 – Signature
I certify that I have conducted a thorough evaluation of the candidate’s skills for operating a forklift.
Evaluator Name (Print)	Evaluator Signature	Date