Appendix D Aerial/Scissor Lift Hands-On Operator Training Evaluation Form Trainee Name: Work Unit: Evaluator Name: Department: Equipment Manufacturer: Date: Model: NOTE: Hands-On Operator Training must be completed for each type of aerial lift utilized. Step Evaluation N/A Pass Fail 1. Pre-use Including but not limited to: safety devices, equipment air/hydraulic/fuel system for cable/wiring inspection harnesses for damage, loose/missing parts, tires and wheels, placards/warnings/and control markings, outriggers/stabilizers and other structures, guardrail system, other items as specified in owner’s manual. 2. Inspect Including but not limited to: drop-offs or holes, Worksite slopes, bumps and floor obstructions, debris, overhead obstructions and electrical hazards, inadequate surface and support to withstand all load forces, wind and weather conditions, presence of bystanders, other unsafe conditions. 3. Function test Done to determine if there are any malfunctions. of lower control station. 4. Utilize fall Face the machine. Maintain 3 point contact with protection ladder/hand rails (two hands, one foot OR two equipment feet, one hand). 5. Function test Done to determine if there are any malfunctions. of bucket / platform / basket control station. 6. Drive and Move approximately 10 feet in a driving mode. creep / inch Creep approximately 5 feet. Verify unit balance forward and and stability. reverse. Step Evaluation N/A Pass Fail
Appendix D Aerial/Scissor Lift Hands-On Operator Training Evaluation Form Trainee Name: Work Unit: Evaluator Name: Department: Equipment Manufacturer: Date: Model: NOTE: Hands-On Operator Training must be completed for each type of aerial lift utilized. Step Evaluation N/A Pass Fail 1. Pre-use equipment inspection Including but not limited to: safety devices, air/hydraulic/fuel system for cable/wiring harnesses for damage, loose/missing parts, tires and wheels, placards/warnings/and control markings, outriggers/stabilizers and other structures, guardrail system, other items as specified in owner’s manual. 2. Inspect Worksite Including but not limited to: drop-offs or holes, slopes, bumps and floor obstructions, debris, overhead obstructions and electrical hazards, inadequate surface and support to withstand all load forces, wind and weather conditions, presence of bystanders, other unsafe conditions. 3. Function test of lower control station. Done to determine if there are any malfunctions. 4. Utilize fall protection equipment Face the machine. Maintain 3 point contact with ladder/hand rails (two hands, one foot OR two feet, one hand). 5. Function test of bucket / platform / basket control station. Done to determine if there are any malfunctions. 6. Drive and creep / inch forward and reverse. Move approximately 10 feet in a driving mode. Creep approximately 5 feet. Verify unit balance and stability. Step Evaluation N/A Pass Fail
appendix_d_-_aerial-scissor_lift_operator_training_evaluation_from.docx