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🏗️ Training & Competence

Aerial Lift Practical Evaluation

Mobile Elevating Work Platform Operator Assessment

📋 Basic Information

Employee Name *

Evaluator Name *

District / Base *

Evaluation Date *

Aerial Lift ID/Model

⚡ Energy Sources Present

Select all energy sources present during this operation:

🪨Gravity

🏃Motion

⚙️Mechanical

⚡Electrical

💨Pressure

🧪Chemical

🌡️Temperature

🔋Stored

💀 STKY Assessment

Does this aerial lift operation involve Life-Threatening, Life-Altering, or Life-Ending potential? *

🔴 Yes - High Energy/SIF Potential

🟢 No - Low Energy Operation

🔍 Safety Critical Items

Note: Items marked with red background are safety-critical. Any failure on a critical item results in automatic overall FAIL.

⚠️ Visual Inspection Completed? *

✅ Pass

❌ Fail

⚠️ Load Capacity Chart Verified? *

✅ Pass

❌ Fail

Fluid Levels Checked? *

✅ Pass

❌ Fail

⚠️ Control Functions Tested? *

✅ Pass

❌ Fail

⚠️ Emergency Lowering Function Works? *

✅ Pass

❌ Fail

⚠️ Fall Protection Used (Harness & Lanyard)? *

✅ Pass

❌ Fail

⚠️ Platform Weight Limits Observed? *

✅ Pass

❌ Fail

Smooth, Controlled Movements? *

✅ Pass

❌ Fail

⚠️ Avoids Overhead Hazards? *

✅ Pass

❌ Fail

⚠️ Platform Capacity Not Exceeded? *

✅ Pass

❌ Fail

⚠️ Set Up on Firm, Level Ground? *

✅ Pass

❌ Fail

⚠️ Outriggers Properly Deployed? *

✅ Pass

❌ Fail

⚠️ Exclusion Zone Maintained? *

✅ Pass

❌ Fail

Ground Communication Effective? *

✅ Pass

❌ Fail

⚠️ Tilt Limits Not Exceeded? *

✅ Pass

❌ Fail

⚠️ Proper PPE Used? *

✅ Pass

❌ Fail

⚠️ Electrical Safety Distances Maintained? *

✅ Pass

❌ Fail

⚠️ Only Authorized Personnel in Platform? *

✅ Pass

❌ Fail

Emergency Procedures Understood? *

✅ Pass

❌ Fail

⚠️ Platform Lowered Before Shutdown? *

✅ Pass

❌ Fail

Outriggers Properly Retracted? *

✅ Pass

❌ Fail

⚠️ Equipment Secured in Authorized Area? *

✅ Pass

❌ Fail

💭 Final Assessment

Evaluator Comments

Overall Assessment *

Note: Any safety-critical failure results in automatic FAIL.

✅ PASS - Competent for independent operation

❌ FAIL - Requires additional training

Follow-up Action Required

AnthroSafe™ Field Driven Safety

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