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Job Setup:Set once. Attaches to every form you submit.

🚜 Training & Competence

Loader Practical Evaluation

Heavy Equipment Operator Competency Assessment

📋 Basic Information

Employee Name *

Evaluator Name *

District / Base *

Evaluation Date *

Equipment ID/Number

⚡ Energy Sources Present

Select all energy sources present during this operation:

🪨Gravity

🏃Motion

⚙️Mechanical

⚡Electrical

💨Pressure

🧪Chemical

🌡️Temperature

🔋Stored

💀 STKY (Stuff That Kills You) Assessment

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

🔴 Yes - High Energy/SIF Potential

🟢 No - Low Energy Operation

🔍 Pre-Operation Inspection

⚠️ Conducted thorough walk-around inspection? *

✅ Pass

❌ Fail

Checked hydraulic fluid levels and condition? *

✅ Pass

❌ Fail

⚠️ Verified backup alarm functionality? *

✅ Pass

❌ Fail

Inspected tires/tracks for damage or excessive wear? *

✅ Pass

❌ Fail

🎯 Operational Skills

⚠️ Maintains awareness of personnel in work area? *

✅ Pass

❌ Fail

Operates controls smoothly and precisely? *

✅ Pass

❌ Fail

Demonstrates proper load handling techniques? *

✅ Pass

❌ Fail

⚠️ Maintains proper travel speed for conditions? *

✅ Pass

❌ Fail

⚠️ Keeps bucket low during travel? *

✅ Pass

❌ Fail

🦺 Safety Protocols

⚠️ Uses proper PPE (hard hat, high-vis, safety boots)? *

✅ Pass

❌ Fail

⚠️ Uses seatbelt/ROPS protection? *

✅ Pass

❌ Fail

⚠️ Follows LOTO procedures when required? *

✅ Pass

❌ Fail

⚠️ Maintains exclusion zone/spotter awareness? *

✅ Pass

❌ Fail

🛑 Shutdown Procedures

Lowers bucket to ground before shutdown? *

✅ Pass

❌ Fail

Engages parking brake and removes key? *

✅ Pass

❌ Fail

⚠️ Secures equipment in authorized parking area? *

✅ Pass

❌ Fail

💭 Evaluator Comments & 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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