Scissor Lift Operator Evaluation
Evaluate the skills, safety awareness, and operational knowledge of scissor lift operators.
Operator Full Name
*
First Name
Last Name
Evaluator Full Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pre-Operation Inspection Checklist
*
Rows
Pass
Fail
N/A
Checked fluid levels (oil, hydraulic, etc.)
1
2
3
Inspected tires and wheels
4
5
6
Tested controls and safety devices
7
8
9
Inspected guardrails and platform
10
11
12
Checked for leaks or damage
13
14
15
Knowledge of Safe Operating Procedures
*
1
2
3
4
5
Ability to Recognize and Avoid Hazards
*
1
2
3
4
5
Use of Personal Protective Equipment (PPE)
*
Always uses PPE correctly
Sometimes uses PPE
Does not use PPE
Response to Emergency Situations
*
Understands and follows emergency procedures
Needs improvement
Unfamiliar with procedures
Overall Performance Assessment
*
Unsatisfactory
1
2
3
4
Excellent
5
1 is Unsatisfactory, 5 is Excellent
Comments and Recommendations
Evaluator Signature
*
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