🏗️

Aerial Lift Practical Evaluation

Mobile Elevating Work Platform Operator Assessment

📋Basic Information

Employee Name *

Evaluator Name *

Company *

Location *

Evaluation Date *

Aerial Lift ID/Model

⚡Energy Sources Present (Select all that apply)

🪨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

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?