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Cal Poly ILT forklift practical evaluation
Instructions: Use this checklist during the field session to evaluate operator proficiency. It can also be used for period evaluation to
ensure that operators are continuing to operate forklifts properly. Per Cal/OSHA regulation 3668 and evaluator is someone who has
the knowledge, training and experience to train operators and evaluate their competence on the equipment they wish to operate.
Faculty and staff with a current forklift certification on the specific type of equipment would be a good choice for evaluator.
OPERATOR BEHAVIORS
COMMENTS
Pre-use Inspection
1. Completed daily inspection checklist?
YES NO
2. Look for Damage.
YES NO
3. Submitted any deficiencies found in daily
inspection to maintenance
YES NO
Picking Up The Load
1. Square up on the center of the load.
GOOD FAIR POOR N/A
2. Stop with the fork tips about 1 foot from the load.
GOOD FAIR POOR N/A
3. Clear personnel from the area near the load.
GOOD FAIR POOR N/A
4. Level the forks; then slowly drive forward until the
load contacts the carriage.
GOOD FAIR POOR N/A
5. Lift the load carefully and smoothly until it is clear.
GOOD FAIR POOR N/A
6. Tilt the mast back slightly to stabilize the load.
GOOD FAIR POOR N/A
7. Look over both shoulders.
GOOD FAIR POOR N/A
8. After out and stopped, lower the load to travel
height.
GOOD FAIR POOR N/A
Traveling
1. Do not raise or lower the load and forks while
traveling.
GOOD FAIR POOR N/A
2. Maintain a safe speed.
GOOD FAIR POOR N/A
3. Observe all traffic rules, warning signs, floor load
limits and overhead clearances.
GOOD FAIR POOR N/A
4. Keep arms and legs inside the forklift.
GOOD FAIR POOR N/A
5. Follow other vehicles at safe distance.
GOOD FAIR POOR N/A
6. Slow down when cornering.
GOOD FAIR POOR N/A
7. Use the horn to alert others.
GOOD FAIR POOR N/A
8. Travel with the load facing uphill while on a ramp
or incline.
GOOD FAIR POOR N/A
Operator Name/ Department Evaluator Name
Date of Evaluation Equipment Operated
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9. Stop smoothly.
GOOD FAIR POOR N/A
Putting Down A Load COMMENTS
1. Make sure there is sufficient clearance for the load.
GOOD FAIR POOR N/A
2. Clear personnel from the area near the load.
GOOD FAIR POOR N/A
3. Square up to the location; then stop about 1 foot
away.
GOOD FAIR POOR N/A
4. Raise the load to placement level.
GOOD FAIR POOR N/A
5. Move slowly forward.
GOOD FAIR POOR N/A
6. If the load is on a pallet, lower it into position and
lower the forks further.
GOOD FAIR POOR N/A
7. Look over both shoulders before backing out.
GOOD FAIR POOR N/A
8. Back straight out until the forks have cleared.
GOOD FAIR POOR N/A
9. Lower the forks to traveling position.
GOOD FAIR POOR N/A
Parking
1. Fully lower the forks.
GOOD FAIR POOR N/A
2. Neutralize the controls.
GOOD FAIR POOR N/A
3. Set the brakes.
GOOD FAIR POOR N/A
4. Turn off the power.
GOOD FAIR POOR N/A
5. If parked on an incline, block the wheels.
GOOD FAIR POOR N/A
6. Park only in authorized areas.
GOOD FAIR POOR N/A
Fueling And Battery Recharging
1. Engine off.
GOOD FAIR POOR N/A
2. Fire extinguisher nearby.
GOOD FAIR POOR N/A
3. Proper personal protective equipment worn.
GOOD FAIR POOR N/A
4. Safe fueling and battery recharging procedures
followed.
GOOD FAIR POOR N/A
5. Spills cleaned up immediately.
GOOD FAIR POOR N/A
Hazards specific to operating a forklift at Cal
Poly? Instructor to communicate any Cal Poly
specific hazards to operator such as uneven surface
locations, blind turns.
Please document specific hazards, if
any in comments.
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Evaluator Signature: __________________________ Operator Signature: _________________________
Please scan and email completed form to Environmental Health & Safety for completion credit. Learning
Management System will notify operator in 3 years of need to requalify. If you have any questions please
contact Christina Juarez at 805-756-6674
Based on my evaluation, the operator has successfully completed the evaluation and is
qualified to operate the following equipment:
