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Thank you!Electric BuggyDetailsSafety ChecksOperationShutdownFinishCompany DetailsDate*Start Time*Assessor*Andrew McGuireGavin MichalowskyAndrew HawesSend TCR to*Andrew McGuireGavin MichalowskyAndrew HawesCompany*Please selectVisy BoardVisy GlassVisy GlamaVisy PlasticsVisy Recycle PlasticsVisy CogenVisy RecyclingVisy CoatingsVisy Beverage CanVisy CCPVisy FoodVisy Boxes and MoreVisy LogisticsVisy Logistics VP2Visy Logistics VP4Visy Logistics VP5Visy Glass RecyclingVisy Paper Mill VP1Visy Paper Mill VP2Visy Paper Mill VP3&6Visy Paper Mill VP4Visy Paper Mill VP5Visy Paper Mill VP7Visy Paper Mill VP8WoolworthsLoscamSaputoKempe EngineeringIplex PipelinesDonKRRocla PipesRemedy DrinksKempe Engineering - CogenMoira Mac'sGale PacificAddress VICPlease select27 Doriemus Dr, Truganina VIC 3029299 McKoy St, West Wodonga VIC 369022 Radford Road, Reservoir, VIC, 307313 Reo Crescent, Campbellfield, VIC, 3061(Coolaroo)26 Whiteside Road, Clayton, VIC, 3168 118 Hammond Rd, Dandenong, VIC, 317546-48 Dohertys Road, Laverton, VIC, 302585 McKellar Way, Epping, VIC, 3076 405 Goulburn Valley Hway, Shepparton, VIC, 36305 Chifley Drive, Moorabbin Airport, VIC, 319442-44 Buckland Street, Clayton, VIC, 3168 28 Bilston Dr, Barnawartha North VIC 369151 Nathan Road, Dandenong South, VIC 3175Factory 20, Mayfair Estate, Mcdowalls Rd, East Bendigo VIC 355020 - 40 Booker St, Spotswood, VIC, 3015 36 Charles Street, Coburg North, VIC, 305851 Nathan Road, Dandenong South, VIC 3175Cnr Banksia and Waterdale Road, Banksia St, Heidelberg VIC 3081708 Princess Highway, Springvale, Vic, 3171282 Thompson Rd, North Geelong VIC 3215145 Woodlands Drive, Braeside, Vic, 31959/15 Foundation Rd, Truganina VIC 3029Address QLDPlease select298-300 Stapylton-Jacobs Well Road, Stapylton, QLD, 4207143 Pearson Road, Yatala, QLD 420738 Cobalt Street, Carole Park, QLD, 430031 Stradbroke Street, Heathwood, QLD, 4110168 Paringa Road, Murarrie, QLD, 4172223 Orchard Rd, Richlands, QLD, 4077110 Eastlake St, Carrara, QLD, 421112 Concorde Place, Caboolture, QLD, 4510227 Ewing Road, Woodridge QLD, 411459-69 Home Hill Road, Ayr, QLD, 480711 Rifle Range Road, Gayndah, QLD, 4625 Shed 4, 11 Production Street, Bundaberg, QLD, 467037 Weston Drive, Gatton, QLD, 434313-17 Martin Tenni Drive, Mareeba, QLD, 4880Cnr Warwick & Chandler Roads, Bowen, QLD, 480522 Clifford Road, Innisfail, QLD, 4860 Hewitt Siding - Bruce Highway, Tully, QLD, 4854137 Montague Rd, South Brisbane, QLD, 410128 Magnesium Dr, Crestmead, QLD, 413296 Tile St, Wacol, QLD, 407636 Suscatand St, Rocklea, QLD, 4106Address NSWPlease select2 Leewood Drive, Orange, NSW, 2800102/122 Gipps Road, Smithfield, NSW, 216411 Bulmer Avenue, Griffith, NSW, 268041-51 Scrivener St, Warwick Farm, NSW, 217031 Terry Ct, Thurgoona NSW 2640Gate 9, 41-51 Scrivener Street, Warwick Farm, NSW, 21706 Herbert Place, Smithfield, NSW, 2164126 Andrews Road, Penrith, NSW, 27501302 Snowy Mountains Hwy, Tumut, NSW, 27206-10 Burrows Road South, St Peters, NSW, 20441/10 Williamson Road, Ingleburn, NSW, 256520 Williamson Road, Ingleburn, NSW, 256543 Bay Road, Taren Point, NSW, 2229133 Reddalls Road, Kembla Grange, NSW, 252611A Ferndell Street, South Granville, NSW, 214230 Perry St, Matraville, NSW, 203671 Marigold Street, Revesby, NSW, 22128 Works Place, Milperra, NSW 2214170 Andrews Rd Penrith, NSW, 275025 Enterprise Drive, Beresfield, NSW 2322 86 Yass Rd, Queanbeyan East, NSW, 2620 23-25 Coombes Dr, Penrith NSW 2750Address SAPlease selectShed G, 25 - 59 Bedford Street, Gillman, SA, 5013 Shed C, 25 - 59 Bedford Street, Gillman, SA, 501324-26 White Road, Gepps Cross, SA, 50943/10 Sharp Court, Mawson Lakes SA 50953/9 Sharp Court, Mawson Lakes SA 50951/9 Sharp Court, Mawson Lakes SA 50952 Matson Court, Gillman, SA, 501316-20 Johansson Rd, Wingfield, SA, 5013181 Morphett Rd, North Plympton, SA, 5037McKay Road, Berri, SA, 5343 625 Port Rd, West Croydon, SA, 500825 Mill Ct Kilburn SA 5084Address WAPlease select49 Peel Rd, O'Connor, WA, 61636 Modal Street, Canningvale, WA, 61052-36 Bannister Road, Canning Vale, WA, 615594A Harrison Road, Forrestfield, WA, 605890 Collins Street, Donnybrook, WA, 6239Unit 3, 196 Bannister Road, Canning Vale, WA, 6155Ramsay Terrace, Donnybrook, WA, 6239OtherPlease select3/5 Foster Street, Queanbeyan, ACT, 262010 Export Drive, East Arm, NT, 08228 Kelcey Tier Road, Spreyton, TAS, 705085 Langley Road, Manukau City, Auckland, 2104235 Roscommon Road, Wiri, Auckland, 2104122 Ingram Road, Rukuhia, Hamilton 3282107 Kerwyn Ave, East Tamaki, Auckland 201321 Allens Rd, East Tamaki, Auckland, 210329 Victoria Street, Onehunga, Auckland, 1061211 Albany Highway, Albany, Auckland, 633078 Treffers Road, Wigram, Christchurch20-30 Bell Road South, Gracefields, WellingtonOther Address (if not in dropdown menu)Operator DetailsOperator Name*DOB*Assessment1st Assessment1st Re-Assessment2nd Re-AssessmentEquipment DetailsEquipment Type*Electric BuggyModel*ToyotaLindeKomatsuHysterYaleCrownGrendiaMitsubishiHysterBaoliJungheinrichCapacity*450kg1T1.2T1.5T1.8T2.5T3T3.5T4T4.5T4.5T5T6T7T8T10T11T12T15T16T18T20T25TPower Type*ElectricOther Information (*Not able to be entered in the above fields*) Performance Criteria Unit 1 - Conduct Pre-Operational ChecksOutcomeCompetentNot Yet CompetentIssues Identified*NoneSee CommentsObservation Elements - Capacity plate on buggy - Underneath for fluid / oil leaks - Warning decals - Condition of load tray / attachment /secure points - Back rest condition - Structure and overhead guard (If fitted) - Tyres condition and pressure damage/wear - Battery water level and connections - Condition of seat and seat belt(if fitted) - Mirrors clean & not cracked(if fitted) - Electronic devices Attached & Secured - Fire suppression system / Fire Extinguisher (If fitted) POST START CHECK - Adjust seat and mirrors - Identify controls - Functioning Lights & Reversing light (if fitted) (Test) - Forward & Reverse movement - Warning devices – Horn / Reversing Beeper (Test) - Gauges (Check) - Brakes and hand brake (Test) - Steering (Test full lock to lock) - Deadman(Test)CommentsQuick CommentsSatisfactorily Completed Unit 1Struggled to identify all elements of the pre-operational check and as a result was unable to provide a satisfactory pre-operational checkStruggled to identify all elements of the pre-operational check and required a lot of coaxing to identify the remaining elementsProvided a pre-operational checklist to use and studyOperator stated that they do not conduct a pre-operational inspectionHowever the operator was able to provide a satisfactory pre-operational checkinformed the operator of the consequences for not conducting a pre-operational checkI informed the operator of their responsibilities and obligationsUnit 2 - Inspect Site and Work PlansOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements - Checks for obstacles / hazards / ground condition - Apply controls for obstacles / hazards / ground conditions - Know and use site Traffic management procedures - Wear required PPE (High Vis, Safety glasses etc) - Understands load limit requirements - Identifies rapid roller doors and the correct procedure for entry(If applicable) CommentsQuick CommentsSatisfactorily Completed Unit 3Struggled to identify hazards in the workplaceStruggled to identify traffic rules in the workplace Unit 3 - Equipment OperationsOutcomeCompetentNot Yet CompetentIssues Identified*NoneSee CommentsObservation Elements - Seat belt is worn correctly (If fitted) - Check over both shoulders prior to reversing - Observe - Checks corners / blind spots / pedestrians / traffic - Smoothness of vehicle operation - Acceleration sense - Correct use of warning devices - Maintains safe distance from other vehicles and pedestrians - Ensure load is secured - Speed - Travel speed to conditions - Control - Maintains safe control at all times - Ensure correct use of Park brake - Ensure correct control used - Good steering control - Observation and Planning used - Confidence Level - Ensure understands correct use of LOTO - Good attitude towards Buggy safety & operationsCommentsQuick CommentsSatisfactorily Completed Unit 3turning with the load raisedload not hard against the heel of the forksOperated in an unsafe mannerbear hugging the reelsgrabbing reels at the baseRotate attachment while driving.traveling with the load above axle heighthas poor attitude towards forklift operations I informed the operator of the consequences for this unsafe actionI informed the operator of the consequences for these unsafe actionsUnit 4 - Obstacles & Control ChecksOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements Drives and reversing in to and out of locations at the Trainers request - Reverses in to and out of location - Drives in to and out of location - Uses warning devices where required. - Demonstrates correct observation techniques.CommentsQuick CommentsSatisfactorily Completed Unit 4Failed correct observation techniques Unit 5 - Shutdown EquipmentOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements - Parks buggy in correct location - Appropriate gear is selected when parking the vehicle - Applies Park Brake - Engine power is turned off - Battery connected to charger CommentsQuick CommentsSatisfactorily Completed Unit 5Park Brake not appliedEngine power is not turned offUNIT 6 - Secure the SiteOutcomeCompetentNot Yet CompetentIssues Identified*NoneSee CommentsObservation Elements - Understands where not to park buggy • First Aid facilities /Refueling Station • Access points / Emergency Fire Exits • Walkways / Blind Corners - Mounts / Dismounts Correctly (Using 3 points of contact) CommentsQuick CommentsSatisfactorily Completed Unit 6Mounts / Dismounts buggy incorrectly not using 3 points of contactParked buggy in an unsafe placeAsked the operator to demonstrate the correct method used to dismount from a buggyThe operator demonstrated the correct method of 3 points of contactI informed the operator of the consequences for this unsafe actionUnit 7 - Battery ChargingOutcomeCompetentNot Yet CompetentNot AssessedIssues IdentifiedNoneSee CommentsObservation Elements - Shuts down buggy as per shutdown procedure Electric - Follows SWP when connecting to a battery charger - Follows SWP when disconnecting from a battery charger - Understands when to top up battery water levels(before Charging) - Understands correct emergency proceduresCommentsQuick CommentsSatisfactorily Completed Unit 7Did not shut down buggy as per shutdown procedureDid not wear correct PPE when refuellingDid not follow SWP when refuellingDoes not understand correct emergency proceduresHas very good knowledge of the battery charging SWPConducted verbal assessmentNot Assessed Unit 8 - QuestionnaireNo. of Questions*Please select151614N/AQuestions Assist*Please select123456789101112131415N/AQuestions Correct*Please select161514131211109876543210N/AVerbal Assessment RequiredNoYesQuestion Numbers Assisted With012345678910111213141516AllN/ACommentsQuick CommentsCould not read or writeCould not understand the questionsCould not understand EnglishCould not write in EnglishUsed Google TranslatorFinal OutcomeFinal Outcome*CompetentNot Yet CompetentIssues Identified*Please selectYesNoRequires further training*NoYesFinish Time*GradingExcellentVery GoodAveragePoorVery PoorOverall %Knowledge %Skills %Knowledge Grade 15 - Excellent 100% 14 - Excellent 93% 13 - Very good 87% 12 - Average 80% 11 - Average 73% 10 - Average 67% 9 - Poor 60% 8 - Poor 53% 7 - Poor 47% 6 - Poor 40% 5 - Poor 33% 4 - Poor 27% 3 - Poor 20% 2 - Poor 13% 1 - Poor 7%Skills Grade 7 - Excellent 100% 6 - Very good 86% 5 - Average 71% 4 - Poor 57% 3 - Poor 43% 2 - Poor 29% 1 - Very Poor 14%Comments on Overall PerformanceQuick CommentsVery confident and competent operatorVery good operator, however lacks knowledge of site policies and proceduresVery good operator, very good knowledge of site policies and proceduresGood operator, however lacks knowledge of site policies and proceduresGood operator, very good knowledge of site policies and procedures, also lacks knowledge on hazard identification and knowledge of site traffic rules, also lacks knowledge on hazard identification, also lacks knowledge on site traffic rulesSignaturesOn signing this training/assessment course completion form, it is acknowledged that the above-named training course has been completed by the named Operator.Assessor SignatureOperator Signature Submit
