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 the load weight Within 10 pounds (plus or minus 2 pounds)
01.2 Locate the load center of gravity Within ? leveling bubble of accuracy
01.3 Determine forklift specifications Comprehensive and accurate
01.4 Check travel route and clearances Comprehensive and accurate
01.5 Check floor loading limits Comprehensive and accurate
02.0 SAFETY CONSIDERATIONS PERFORMANCE MEASURE Sat Unsat N/A 02.1 Establish a safe work zone Restrict and control pedestrian traffic
02.2 Ensure use of PPE Don safety shoes, hard hat and safety glasses
02.3 Ensure crew member/s T&Q is current Total accuracy 02.4 Ensure compliance with ES&H Subject Areas Total compliance 03.0 PRE-OPERATION CHECK PERFORMANCE MEASURE Sat Unsat N/A 03.1 Perform a forklift pre-start check Zero omissions from provided checklist
03.2 Perform a forklift pre-operation check Substandard conditions identified, if any
03.3 Ensure operational readiness or deadline Complete checklist and make proper determination
03.4 Charge DC forklift battery Adhere to manufacturer’s guidance
03.5 Replace LPG fuel tank Adhere to manufacturer’s guidance
04.0 DRIVING AND MANEUVERING SKILLS PERFORMANCE MEASURE Sat Unsat N/A 04.1 Drive forward/backward empty (slalom course) Traffic cone spacing, 6-12 inches wider than forklift width 04.2 Zero contact with traffic cones during operations 04.3 Forklift maneuvering and control adequate 04.4 Driving speed slow and steady
04.5 Minimum disturbance of forklift attitude 04.6 Visibility & awareness of surroundings adequate 04.7 Maintain safe clearance from dock or platform edges 04.8 Drive F/B with pallets (slalom course) Same as above listed standards
04.9 Drive across railroad tracks/road bumps Cross tracks/bumps diagonally
04.10 Drive up and down slopes/ramps Safe driving practices on slopes/ramps – up and down
04.11 Drive in/out of boxcars & trucks Secure dock-plates & wheel locks to specification 04.12 Park the forklift and safely leave it unattended Zero hazards created or safety protocols violated 05.0 GENERAL LOAD HANDLING SKILLS PERFORMANCE MEASURE Sat Unsat N/A 05.1 Lift and relocate a symmetrical load Load stable, balanced and secure during movement
05.2 Lift and relocate an asymmetrical load Same as above listed standards 05.3 Stack and restack/shuffle 4 pallets All pallet edges aligned (+ or - 2 inches) 05.4 Operator side shifter assembly if applicable Load aligned with the forklift load center (+ or - 2 inches) 06.0 SPECIAL LOAD HANDLING SKILLS PERFORMANCE MEASURE Sat Unsat N/A 06.1 High stacking Performance standards same as items 04.0 & 05.0 06.2 Wide or high load Performance standards same as items 04.0 & 05.0 06.3 Asymmetrical load Performance standards same as items 04.0 & 05.0 06.4 Hazardous material load Performance standards same as items 04.0 & 05.0 07.0 ATTACHMENTS QUALIFICATION CODE PERFORMANCE MEASURE Sat Unsat N/A 07.1 Forklift Extensions TQ-FLQUAL-FORKEXT Connect/disconnect device/s according to specifications
07.2 Barrel Lift or Claw TQ-FLQUAL-DRUMLIFT Demonstrate competent use of the indicated devices 07.3 Pallet Pusher TQ-FLQUAL-PALPUSH Performance standards same as items 04.0, 05.0 & 06.0 07.4 Gas Cylinder Pallet TQ-FLQUAL-GASPAL Performance standards same as items 04.0, 05.0 & 06.0 07.5 Rad Material Pig TQ-FLQUAL-RADPIG Performance standards same as items 04.0, 05.0 & 06.0 08.0 SECURE THE WORK AREA PERFORMANCE MEASURE Sat Unsat N/A 08.1 Secure the forklift in the designated area Adhere to forklift manufacturer & BNL safety guidance