MEWP Operator Practical Evaluation Form
Use this form to record a practical evaluation of a MEWP operator’s performance during equipment operation.
Operator and Evaluation Details
Operator Name
*
Evaluator Name
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
MEWP Type/Model Used
*
Worksite / Task Location or Scenario
*
Practical Performance Assessment
Pre-Use Inspection
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Completes required pre-use inspection
1
2
3
4
Identifies defects or deficiencies appropriately
5
6
7
8
Safe Setup and Stabilization
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Positions equipment on suitable ground
9
10
11
12
Applies stabilizers, outriggers, or leveling controls correctly
13
14
15
16
Maneuvering and Control
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Operates controls smoothly and accurately
17
18
19
20
Maintains safe travel speed and positioning
21
22
23
24
Working at Height Practices
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Uses fall protection and required restraints correctly
25
26
27
28
Maintains stable stance and avoids unsafe body positioning
29
30
31
32
Hazard Awareness
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Recognizes overhead, ground, and nearby-work hazards
33
34
35
36
Adjusts actions appropriately to changing site conditions
37
38
39
40
Emergency Response and Stop-Work Judgment
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Stops work when unsafe conditions are identified
41
42
43
44
Responds appropriately to emergency or malfunction scenarios
45
46
47
48
Outcome and Comments
Overall Result
*
Competent
Not Yet Competent
Evaluator Comments and Deficiencies
Required Follow-up or Retraining Notes
Submit Evaluation
Should be Empty: