QHSE DEPARTMENT

FORKLIFT OPERATOR SAFETY EVALUATION

Client Company   Area   Product   Process   Type   N° N°
Document N° :
- - - HSE - F - 0013 Rev 1

Evaluation date      

Name of evaluated driver      
Evaluation performed by      
Date of forklift training      

I. COMMON MANDATORY REQUIREMENTS

NOT NOT
THE DRIVER YES NO OBSERV APPLICABL COMMENTS
ED E
* Checks the adequacy of the forklift to the handling operation planned                        
* Knows the forklifts’ safety features and how to properly use them (protection for drivers, shield, load
                       
backrest, seat adjustments, seatbelts and necessary PPE)
* Knows the mechanism and safety devices (circuit breaker, brake service, or key blocking device ...)                        
* Knows the meanings of the different pictograms and signage                        
* Understands the load plate and deduces the stability conditions of the forklift                        
* Identifies the main risks encountered on a particular itinerary or work route                        
* Knows and respects the safe driving rules, storage rules and the traffic management plan of the site                        
Moves straight forward and backward without and with load                        
Circulates in curve (slalom, cornering "S") forward and in reverse without and with load                        
Travels with control on different ground types without and with load at a safe speed                        
* Adapts (or reduces) speed to traffic conditions: ground, loads, turns and turn with caution                        
Drives safely on public roads complying all the local regulation and internal standards                        
Inserts slowly the forks into the pallet in order to avoid puncturing loads or pallets                        
* Lifts the load straight up until it is clear, then tilt slightly back, drive with the load against the backrest,
                       
making sure load is stabilized
 QHSE DEPARTMENT
FORKLIFT OPERATOR SAFETY EVALUATION
Client Company   Area   Product   Process   Type   N° N°
Document N° :
- - - HSE - F - 0013 Rev 1

NOT NOT
THE DRIVER YES NO OBSERV APPLICABL COMMENTS
ED E
* Performs stacking and unstacking with limited maneuvering (mass storage or pallet rack)                        
* Loads or unloads at all levels of a pallet rack and especially up to 5 m (16 feet)                        
* Moves with the forks at the correct height (approx. 15 cm or 6 inches) without and with load                        
* Checks to ensure that no one is in the maneuvering area before moving loads                        
Loads or unloads a transport unit after verifying that it’s immobilized (rigging, braking, placing a trestle if
                       
unhitching)
Ensures correctly, from ground level, loading and unloading on the lateral side of a truck or trailer                        
* Takes, transports and deposits long or voluminous load properly                        
Travels with load facing uphill while travelling down a ramp or incline                        
* Uses horn correctly before moving back, at intersections, blind spots, corners, etc.                        
* Slows down when approaching pedestrians, passageways and work areas                        
* Looks in the direction of travel ; Gives a look back before moving back                        
Maintains a safe distance from the dock edge or other drop offs                        
Keeps arms and legs inside forklift and wears seatbelt if necessary                        
Follows other vehicle at a safe distance (at length of 3 forklifts spacing)                        
Makes sure there is sufficient clearance for the load when putting it down                        
* Sets the parking brake, fully lower the forks and remove the key when leaving the forklift                        
Parks only in designated areas                        

The driver must have succeeded into points marked with an asterisk. If not, he will need more training before driving in the site.
Temporary workers & employees of external companies who may need to drive a forklift are required to provide a valid forklift certificate and be successful in all points marked with an asterisk in order to drive in
the site.
 QHSE DEPARTMENT
FORKLIFT OPERATOR SAFETY EVALUATION
Client Company   Area   Product   Process   Type   N° N°
Document N° :
- - - HSE - F - 0013 Rev 1

II. LOCAL MANDATORY REQUIREMENTS

NOT NOT
THE DRIVER YES NO OBSERV APPLICABL COMMENTS
ED E
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       

The driver must have succeeded into points marked with an asterisk. If not, he will need more training before driving in the site.
Temporary workers & employees of external companies who may need to drive a forklift are required to provide a valid forklift certificate and be successful in all points marked with an asterisk in order to drive in
the site.

Assessor’s signature: Driver’s signature: