Machine Operation Competency Assessment Form
Evaluate operator competency, safety knowledge, and readiness to operate machinery.
Operator Full Name
*
First Name
Last Name
Machine/Equipment Name and Facility
*
Years of Prior Experience Operating This or Similar Machinery
*
Have you completed formal training or certification for this equipment?
*
Yes
No
In Progress
Practical Competency Assessment
*
Rows
Not Competent
Partially Competent
Competent
Highly Competent
Machine Start-Up Procedure
1
2
3
4
Operation Controls
5
6
7
8
Shutdown Procedure
9
10
11
12
Routine Maintenance
13
14
15
16
Rate the Operator's Knowledge of Safety Procedures
*
No Knowledge
1
2
3
4
Excellent Knowledge
5
1 is No Knowledge, 5 is Excellent Knowledge
Hazard Recognition: Identify and Respond to Common Hazards
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Knowledge of Emergency Response Procedures
*
None
1
2
3
4
Comprehensive
5
1 is None, 5 is Comprehensive
Assessor's Outcome/Recommendation
*
Competent to Operate
Requires Further Training
Not Competent
Assessor Comments
Submit Assessment
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