Injury Illness Prevention Plan - Flipbook - Page 167
Health and Safety Program Manual
Teamwrkx
Construction, Inc.
Issue Date: 10/16/23
Revision Date: 10/16/23
Heavy Mobile Equipment Operation
Reference: A-11
APPENDIX B
HEAVY EQUIPMENT/MOBILE EQUIPMENT OPERATOR TRAINING CERTIFICATION FORM
Worker Name: _______________________________________________________________
Department: ________________________________________________________________
Location: ___________________________________________________________________
Equipment/Make/Model: ______________________________________________________
Trainer Name: _______________________________________________________________
Training Date(s): _____________________________________________________________
Training included the following topics. Instructor should indicate and initial the dates that a particular topic
was completed.
Equipment-Related Topics
Date
Topic
Operating instructions, warnings, and precautions for the types of equipment the
operator will be authorized to operate
Differences between the equipment and an automobile (e.g., turn radius, braking
ability, visibility of surroundings, blind spots, etc)
Equipment controls and instrumentation; where they are located, what they do,
and how they work
Engine or motor operation
Steering and maneuvering
Visibility (including restrictions due to loading).
Implement and attachment adaptation, operation, and use limitations
Equipment capacity
Vehicle stability
Equipment Inspection and Maintenance Requirements (See Daily Heavy
Equipment Inspection Form)
Refueling and/or charging and recharging of batteries
Operating limitations
Any other operating instructions, warnings, or precautions listed in the operator's
manual for the types of equipment that the worker is being trained to operate
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Trainers
Initials