Equipment Familiarization Checklist Form
Complete this form to confirm understanding and readiness to operate the specified equipment.
Operator Name
*
First Name
Last Name
Date of Familiarization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Name/Type
*
Equipment Serial/Asset Number
Have you reviewed the operating manual for this equipment?
*
Yes
No
Do you understand the safety procedures associated with this equipment?
*
Yes
No
Have you completed a hands-on demonstration of equipment operation?
*
Yes
No
Are you aware of the emergency procedures for this equipment?
*
Yes
No
Supervisor/Trainer Name
First Name
Last Name
Additional Comments or Notes
Submit Checklist
Should be Empty: