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Forklift Operator Job Performance Measure

By Victoria Hamilton,2014-08-09 04:17
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Forklift Operator Job Performance Measure

    Forklift Operator Job Performance Measure (TQ-FORKLIFT-P)

    (11/16/05)

     Life/Guest/Contractor Number Department/Division Candidate Name: Date JPM Completed Bldg. Number where JPM Performed Evaluator Name:

     Prerequisite Information

    Prerequisites and practice/observation activity must be completed before job performance measure is administered.

    TQ-FORKLIFT (Web Course) Completion Date

    Practice or Observation Activity Performed as indicated below: ___________

     Evaluator’s Initials

     New Operator Hands-on Training:

    The evaluator identified above or the candidate’s supervisor, identified on the back of this form, verifies that the subject candidate (new operator) has been provided with hands-on training and practice time under the direct supervision of

    qualified operator or trainer/examiner and has demonstrated satisfactory competence in the performance measures

    prescribed by this checklist.

    ; Approximate total hands-on training hours: __________

    ; Administer the JPM

     Incumbent Operator Competence/Proficiency:

    The evaluator identified above or the candidate’s supervisor, identified on the back of this form, has observed the above-named candidate (incumbent operator) operating the specified forklift/s, and using attachments identified below, during

    the performance of routine work on multiple occasions in a competent and proficient manner.

    ; Approximate total observation hours: __________

    ; Administer the JPM

     Equipment Qualifications Mark those successfully demonstrated. Forklift Classifications Ton

    Forklift Range Qualification Type Lift Class Description Options Codes Code

    TQ-FLQUAL-E-5T Electric 4 I Counterbalanced, sit-down, 3 wheels Up to 5 Ton

    TQ-FLQUAL-ES-7T Motor 5 I Counterbalanced, sit down, solid tires Up to 7 Ton

    TQ-FLQUAL-EP-7T Rider 6 I Counterbalanced, sit down, pneumatic tires Up to 7 Ton

    TQ-FLQUAL-EWL-2T Electric 2 III Low-lift pallet Up to 2 Ton

    TQ-FLQUAL-EWH-5T Motor 5 III High lift, reach type Up to 5 Ton Walkie TQ-FLQUAL-EWC-5 T 7 III High lift counterbalanced Up to 5 Ton

    TQ-FLQUAL-ICRS-4T IC 3 IV Counterbalanced sit-down, solid tires Up to 4 Ton

    TQ-FLQUAL-ICRS-7T Engine Rider 3 IV Counterbalanced sit-down, solid tires Up to 7 Ton

    TQ-FLQUAL-ICRP-4T IC 4 V Counterbalanced sit-down, pneumatic tires Up to 4 Ton

    TQ-FLQUAL-ICRP-7T Engine Rider 4 V Counterbalanced sit-down, pneumatic tires Up to 7 Ton

    TQ-FLQUAL-RT-7 Rough Terrain 1 VII All types Up to 7 Ton

     Other

    Forklift Attachment Qualifications

     Mark those successfully demonstrated

    Type Attachment Attachment Qualification Codes

     Fork Extensions TQ-FLQUAL-FORKEXT

     Barrel Lift or Claw TQ-FLQUAL-DRUMLIFT

     Pallet Pusher TQ-FLQUAL-PALPUSH

     Gas Cylinder Pallet TQ-FLQUAL-GASPAL

     Radiological Material Pig TQ-FLQUAL-RADPIG

Submit form to Training, Building 703, for individuals who have successfully completed this Job Performance Measure.

    Forklift Operator Job Performance Measure (TQ-FORKLIFT-P)

    (11/16/05)

    Signatures verify a competent demonstration of the 8 performance categories listed below and confidence in the candidate’s overall

    ability to utilize the identified forklift/s and attachment/s in a safe manner.

    Evaluator Signature: _____________________________________________________ Date: ____________

    Candidate Signature: _______________________________________________________ Date: ____________

    Supervisor Signature: _____________________________________________________ Date: ____________

Item Category and Steps Standard Rating

    01.0 PLANNING PERFORMANCE MEASURE Sat Unsat N/A 01.1 Determine t