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Thank you!Forklift PMEForklift, Grab-Bale Clamp, Order Picker, Reach Truck, Turret TruckDetailsSafety 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 PacificCorval GroupSharpe EngineeringAddress 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 3029150 Newlands Road, Coburg North VIC 3058235 Hume Hwy, Somerton Vic 30628 Beyer Rd, Braeside, Vic, 3195Address 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, 4106Unit 1, 21 Stradbroke Street Heathwood, QLD78 Duke Street, Roma QLD 4455Address 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 2750Warehouse 1B, 7 Dursley Road, Yennora, NSW 2161117 R W Henry Dr, Ettamogah NSW 2640Address 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 5084523 South Road, Regency Park SA 5010Address 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-AssessmentLicence #*Expiry Date*State*VICQLDNSWWASAACTTASNTNZLicence Class*Email Renewal Reminder ToCopy of Licence* Upload% Completed02nd File Upload Upload% Completed0Equipment DetailsEquipment Type*Forklift (Counterbalance)Forklift Paper Roll Clamp (Grab)Forklift Bale ClampOrder PickerReach Forklift TruckTurret TruckNarrow Aisle ForkliftSideloaderMantiou Rough TerrianCombilift/SideloaderModel*ToyotaLindeKomatsuHysterYaleCrownGrendiaMitsubishiHysterBaoliJungheinrichCatCapacity*1T1.2T1.5T1.8T2T2.5T3T3.5T4T4.5T4.5T5T6T7T8T10T11T12T15T16T18T20T25TPower Type*LPGCNGElectricDieselPetrolUses Attachments*ForksSlippersJIBPaper Reel Clamp (Grab)Bale Clamp Safety CageFork SpreaderDouble Fork SpreaderDrum LifterBin TipperRotatorDouble Pallet HandlerBulk Bag Prong JibFixed Prong Drum PositionerHook & Tow JibTarp SpreaderCrane / Forklift Spreader BeamCarpet SpikeFork Spreader ClampOther TypesOther Information (*Not able to be entered in the above fields*) Performance Criteria Unit 1 - Conduct Pre-Operational ChecksOutcomeCompetentNot Yet CompetentIssues Identified*Please selectNoneSee CommentsObservation Elements - Capacity plate on Forklift and compliance plate on attachment - LPG compliance plate, cylinder date and condition and secured correctly (if applicable) - Underneath forklift fluid / oil leaks - Warning decals - Condition of fork arms / attachment /locking pins - Mast assembly & back rest condition - Tilt and lift systems check for damage/leaks/wear (Hydraulic Rams) - Structure and overhead guard (Falling Object Protection & Roll Over Protection) - Tyres condition and pressure - Engine oil / Hydraulic oil level - Brake fluid / Power steering fluid (If accessible) - Coolant - Battery water level and connections - Transmission oil (If accessible) - Fan belt obstructions - Air filter indicator (if diesel) - Condition of seat and seat belt - Mirrors clean & not cracked - Hydraulic lines for any damage - RFT Scanner or other electronic devices Attached & Secured - Fire suppression system / Fire Extinguisher (If fitted) - Attachment condition - Attachment pins / chains / secure fittings 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) - Attachment functionality - Functioning hydraulic lever controls (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 - Attachment UseOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements - Checks Capacity plate is readable and ensures correct forklift capabilities - Checks for attachment compliance plate and is readable - Has been approved for the use of attachments - Ensure correct forklift use for attachments - Can explain 3 elements for checking before using any attachment - Understands correct procedure for use of safety cage - Understands lever control lockout process for safety cage - Selects the correct forklift / attachment for the correct task - Understands requirements for the use of a Jib attachment CommentsQuick CommentsSatisfactorily Completed Unit 2Does Not use attachmentsUnit 3 - 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 stacking height 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 4 - Equipment OperationsOutcomeCompetentNot Yet CompetentIssues Identified*Please selectNoneSee CommentsObservation Elements - Seat belt is worn correctly - 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 - Enter / Exit load smoothly without biding - Load positioned correctly relative to attachment before lifting - Load placed in stack location correctly - Load removed from stack location correctly - Load stacked correctly - Raise forks / attachments correctly - Lower forks / attachments correctly - Ensure Attachment is lowered to correct travel height - Load traveled at correct height (below axle height) - Speed - Travel speed to conditions - Control - Maintains safe control at all times - Ensure correct use of Park brake - Ensure correct control used - Ensure checks of rear end swing - Good steering control - Observation and Planning used - Confidence Level - Ensure understands correct use of LOTO - Ensures load is secured - Demonstrates knowledge of racking limitations (If applicable) - Good attitude towards forklift safety & operationsCommentsQuick CommentsSatisfactorily Completed Unit 4turning 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 5 - Obstacles & Control ChecksOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements Remove load from block stack/racking location and relocate into block stack/racking location at a different level.at the Trainers request - Empty load from a block stack/racking location - Replace load back into block stack/racking location Three (3) varied loads suitable for the M.H.E weighting at least 50% of the rated capacity. - Lift 1: From Floor - Lift 2: Medium Level. (Not less than 50% of machine's height capacity) - Lift 3: High Level. (Not less than 75% of machine's height capacity) CommentsQuick CommentsSatisfactorily Completed Unit 5Struggled with load at height Unit 6 - Shutdown EquipmentOutcomeCompetentNot Yet CompetentIssues IdentifiedNoneSee CommentsObservation Elements - Parks Forklift in correct location - Lower fork-arm / attachments to the ground - Appropriate gear is selected when parking the vehicle - Applies Park Brake - Engine power is turned off - Understands LPG cylinder valve shut off - Battery connected to charger (if applicable) CommentsQuick CommentsSatisfactorily Completed Unit 6fork-arm / attachment not lowered to the groundPark Brake not appliedEngine power is not turned offUNIT 7 - Secure the SiteOutcomeCompetentNot Yet CompetentIssues Identified*Please selectNoneSee CommentsObservation Elements - Understands where not to park a forklift • First Aid facilities /Refuelling Station • Access points / Emergency Fire Exits • Walkways / Blind Corners - Mounts / Dismounts Correctly (Using 3 points of contact) CommentsQuick CommentsSatisfactorily Completed Unit 7Mounts / Dismounts forklift incorrectly not using 3 points of contactMounted / dismounted on the wrong side of forklift (Lever side)Parked Forklift in an unsafe placeAsked the operator to demonstrate the correct method used to dismount from a forkliftThe operator demonstrated the correct method of 3 points of contactI informed the operator of the consequences for this unsafe actionUnit 8 - Refuelling / Battery ChargingOutcomeCompetentNot Yet CompetentNot AssessedIssues IdentifiedNoneSee CommentsFueling SystemDeadman PumpPowered PumpElectric ChargerBottle SwapDecanterObservation Elements - Shuts down forklift as per shutdown procedure LPG - Correct PPE worn when refuelling LPG cylinder - Follows SWP when refuelling forklift - Understands correct emergency procedures 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 8Did not shut down forklift 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 SWPHas very good knowledge of the gas refueling SWPConducted verbal assessmentNot Assessed Unit 9 - QuestionnaireQuestions Correct*Please select161514131211109876543210N/ANo. of Questions*Please select151614N/AQuestions Assist012345678910111213141516Verbal Assessment RequiredNoYesQuestion Numbers Assisted With012345678910111213141516AllN/ACommentsOperatorQuick 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 selectYesNoFinish Time*Req's further training*NoYesGradingExcellentVery GoodAveragePoorVery PoorVery GoodOverall %Knowledge %Skills %Knowledge Grade 16 - Excellent 100% 15 - Excellent 94% 14 - Very good 88% 13 - Very good 81% 12 - Average 75% 11 - Average 69% 10 - Average 63% 9 - Poor 56% 8 - Poor 50% 7 - Poor 44% 6 - Poor 38% 5 - Poor 31% 4 - Poor 25% 3 - Poor 19% 2 - Poor 13% 1 - Very Poor 6%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 - Very Poor 7%Skills Grade 8 - Excellent 100% 7 - Very good 88% 6 - Average 75% 5 - Average 63% 4 - Poor 50% 3 - Poor 38% 2 - Poor 12% 1 - Very Poor 13%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 Create Certificate
