Company
Name:
CERTIFICATION
OF RECEIPT OF POWERED INDUSTRIAL TRUCK TRAINING AND EVALUATION
I, acknowledge receipt of training in the general
safety requirements relating to, design, maintenance and use of fork trucks,
tractors, platform lift trucks, motorized hand trucks and other specialized
industrial trucks powered by electric motors or internal combustion
engines. Specifically, I have been
instructed in powered industrial truck operation; lifting & transporting
loads; lift driving & handling; refueling; and safety procedures to be
followed around loading docks and trailers
Training was received on this
day of
, Year
Signature of Employee Date
PERFORMANCE
EVALUATION
day of ,
Year .
Based
on my knowledge, training and experience the above named employee:
Passed
Failed to demonstrate competence and requires re-testing.
Signature of Trainer Date