Excavator SL - Verification of Competency

Excavator - Verification of Competency
Skyline Training & Assessing
This assessment is a verification of competency only in line with Excavator Operations. This assessment does not replace a relevant state or national licence or provide a certificate of competency to the operator.
This form is to be completed by the appropriate Assessor before an operator is to be allowed to operate a piece of plant.
All operators of load shifting plant including excavators, rollers, articulated rear dump trucks, scrapers must:
- Hold the relevant State / National License; or
- Hold a Certificate of Competency for the Plant, from a Registered Training Organisation; or
- Have received the approved training from a Registered Training Organisation and then be placed onTraining Log Book, with appropriate supervision
Please ensure your name matches that of your licence!
Operator's Name*
First NameLast Name
Project*
Employer*
Date of Birth*
DayMonthYear
Date
Plant Item to be Used*
Make / Model*
Operator's Experience of the Plant Item*
Years & Months
Operator's Signature*
Clear
Operator's Email*
example@example.com
Operating Criteria*
Yes No
Does the Operator hold a State Based Licence or High Risk Work Licence for the intended piece of plant to be used? If yes please upload below. 1 2
State Based Licence or High Risk Work Licence for Plant being used:
Cancelof
Operating Criteria*
Yes No
Does the Operator hold a Statement of Attainment for the intended piece of plant to be used? If yes please upload below. 3 4
Statement of Attainment for Plant being used:
Cancelof
Is the Operator on an approved Log Book? If yes please name the supervisor
Name of Supervisor
If No answered to any of the above the operator MUST NOT use the intended piece of plant or equipment.
Please speak to a Supervisor immediately.

	Yes	No
Does the Operator hold a State Based Licence or High Risk Work Licence for the intended piece of plant to be used? If yes please upload below.	1	2

	Yes	No
Does the Operator hold a Statement of Attainment for the intended piece of plant to be used? If yes please upload below.	3	4

Assessor - Results & Comments
Assessor Code:
Office use only! Assessor to enter they code to access next section.
Theory Component
Result
Demonstrates CompetencyNot Demonstrating Competency
Comments
Practical Component

Result
Demonstrates CompetencyNot Demonstrating Competency
Comments
Competency Assessor to Complete
I certify that the above named operator has provided evidence that they are capable and authorised to operate the plant item on this project site.
Assessor's Name
Date
DayMonthYear
Date
Assessor's Signature
Clear
Assessors Position
Should be Empty:

	Yes	No
Conduct a pre-start inspection	5	6
Mount and dismount equipment	7	8
Seat adjustment/seat belt use	9	10
Explain instrumentation and warning devices	11	12
Safely and correctly start the machine	13	14
Move off in the machine (horn signals, brakes/steering check, area clear etc)	15	16
Safely operate the machine for its intended use (horn, 2 way radio, traffic management, approaching other plant, people on ground, load/unload operations, compact, lift)	17	18
Appropriate operating speed	19	20
Explain the emergency procedures for the machine	21	22
Explain the emergency stop and shutdown	23	24
Correctly park up the machine	25	26
Explain the procedure for reporting faults	27	28
Conduct a post operational inspection	29	30
Secure the machine	31	32

Excavator - Verification of Competency

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Theory Component

Practical Component

Competency Assessor to Complete