Aerial Lift Operator Evaluation Form
Evaluate aerial lift operator performance and safety compliance.
Operator Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Name
*
First Name
Last Name
Pre-Operation Inspection Completed?
*
Yes
No
N/A
Personal Protective Equipment (PPE) Worn Correctly?
*
Yes
No
N/A
Operator Awareness of Surroundings and Hazards
*
1
2
3
4
5
Operating Controls and Maneuvering
*
1
2
3
4
5
Assessment of Key Safety Practices
*
Rows
Needs Improvement
Satisfactory
Excellent
Fall protection used
1
2
3
Stability maintained
4
5
6
Proper use of controls
7
8
9
Emergency lowering procedures
10
11
12
Comments or Observations
Overall Operator Performance
*
Poor
1
2
3
4
Outstanding
5
1 is Poor, 5 is Outstanding
Submit Evaluation
Should be Empty: