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SCHNEIDER ELECTRIC North America Safety & Environmental Policy

Procedure Number: SE480 PAGE: 1 of 14 DATE EFFECTIVE: 10/18/11

NAME: Powered Industrial Truck Safety SUPERSEDES: New PURPOSE: The purpose of this procedure is to train prospective industrial truck operators and provide the basis for refresher and annual training.

Reference Regulatory: Reference Mgt. System:

Issued by: Erick Walberth Director, Safety & Environmental SENA

Approved by: Rich Widdowson VP, GSC Global Safety & SERE NA

Review Date:

Attachments Sample-3TUAtt AU3T – PIT Pre-use inspection checklist Sample-3TUAtt BU3T – PIT training outline Sample-3TUAtt CU3T – PIT License Certification Sample-3TUAtt DU3T – PIT Operator Written Evaluation Record Sample-3TUAtt EU3T – PIT Operator Evaluation Answer Key 1) Scope

This procedure applies to all powered material-handling equipment used in an industrial environment. The information in this procedure shall be used to train prospective industrial truck operators and provide the basis for refresher and annual retraining.

2) References

a). ANSI B56.1 b) Manufacturers’ Operations & Maintenance Manuals c) 5TRefer to your federal, provincial, state and local authorities for applicable

Powered Industrial Truck standards. d) Facilities shall maintain procedures for the following;

i) PIT pre-use checklist (see sample ATT A) ii) PIT training outline (see sample ATT B) iii) PIT License Certification (see sample ATT C) iv) PIT Operator Written Evaluation Record (see sample ATT D)

3) Definitions

a) UPowered Industrial TruckU (PIT) – Forklift Trucks, fork trucks, platform lift trucks, motorized hand trucks and other specialized industrial trucks powered by electric motors or internal combustion engines.

b) UApproved Truck or Approved Industrial TruckU – A truck that is listed or approved for fire safety purposes for the intended use by a nationally recognized testing laboratory, using nationally recognized testing standards.

http://intranet.us.schneider-electric.com/us/depts/operate/safetye.nsf/unid/2EA6A643C98B6D2F85257914005BB4C7/$file/SE480A+PIT+-+Pre-Use+Inspection+Checklist.doc

http://intranet.us.schneider-electric.com/us/depts/operate/safetye.nsf/unid/ECC1A44D5ECA14D5852579190047D758/$file/SE480B+PIT+-+Training+Outline.doc

http://intranet.us.schneider-electric.com/us/depts/operate/safetye.nsf/unid/7622EB2D045256CA852579190047F550/$file/SE480C+PIT+-+License+Certification.doc

http://intranet.us.schneider-electric.com/us/depts/operate/safetye.nsf/unid/2F9778E510BF54368525791900481367/$file/SE480D+PIT+-+Operator+Written+Evaluation+Record.doc

http://intranet.us.schneider-electric.com/us/depts/operate/safetye.nsf/unid/56CB978D36CFCE4485257919004836E5/$file/SE480E+Operator+Evaluation+Answer+Key.doc



NAME: Powered Industrial Truck Safety SUPERSEDES: New

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c) UAuthorized OperatorU – An employee who has been designated to operate a PIT and has met the requirements under this program to qualify for an operator’s license.

d) UAttended Operator – UIs within 25ft of a PIT vehicle. e) UUnattended OperatorU – Is beyond 25ft of a parked PIT vehicle f) UPIT LicenseU – The official document that authorizes use of PIT vehicles.

Types of licenses include; badge identification, stickers, or other types of documents that can be shown on demand.

4. Communication & Responsibility

a) Management shall

i) Provide adequate training in the safe operation of all equipment used to move or access materials;

ii) Provide equipment that is safe to operate; iii) Implement an "Out of Service" program for damaged or

malfunctioning equipment; iv) Not allow modification to equipment except those authorized in

writing by the equipment manufacturer; v) Establish and enforce safe operating rules and procedures.

b) Supervisors or their Designees shall

i) Monitor and enforce safe operations of material handling equipment ii) Ensure all equipment is safety checked daily iii) Tag "Out of Service" any damaged or malfunctioning equipment

c) Employees shall

i) Operate only that equipment for which they have been specifically trained and authorized;

ii) Conduct required daily pre-use inspections; iii) Report any equipment damage, malfunctions, property damage or

missing safety gear; iv) Follow all safety rules and operating procedures.




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v) Use appropriate PPE and safety seat belts as appropriate. vi) Operator’s shall inform supervisor before taking any medication that

might impair their ability to operate a PIT.

d) Maintenance or Designee shall ensure

i) Contractor’s required to conduct inspections and maintenance as described in this policy and procedure;

ii) Establish preventive maintenance schedules for all the PIT’s in the facility;

iii) Maintain all records pertaining to PIT maintenance;

e) The Safety & Environmental Representative shall

i) Coordinate, facilitate or perform annual training on PIT as part of the Safety and Environmental training plan.

ii) Ensure that training records are maintained.

5) PROCEDURE

a) All candidates for Powered Industrial Truck (PIT) operators must meet the following basic requirements prior to starting initial or annual refresher training:

i) Must have no adverse vision problems that cannot be corrected by glasses or contacts that would impair safe operation of the PIT

ii) No adverse hearing loss that cannot be corrected with hearing aids, which would impair safe operation of the PIT

iii) No physical impairments that would impair safe operation of the PIT

iv) No neurological disorders that affect balance or consciousness

v) Not taking any medication that affects perception, vision, or physical abilities.

vi) Not under the influence of illegal drugs or alcohol.

b) Training




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Training for Powered Industrial Truck (PIT) Operators shall be conducted by a qualified, experienced operator/instructor, selected by management. S S Internal trainers must be qualified through recognized sources such as train the trainer programs in which current regulatory requirements are clearly spelled out for compliance. All operational training shall be conducted under close supervision. All training and evaluation must be completed before an operator is permitted to use a Powered Industrial Truck (forklift, etc) without continual and close supervision.

5Ti) Trainees may operate a powered industrial truck only:5T

1) Under the direct supervision of persons, selected by management, who have the knowledge, training, and experience to train operators and evaluate their competence; and

2) Where such operation does not endanger the trainee, other employees, other equipment or product

5Tii) Training Content

Training consists of a combination of formal instruction, practical training (demonstrations performed by the trainer and practical exercises performed by the trainee), and evaluation of the operator's performance in the workplace.

5Tiii) Initial Training:5T Powered industrial truck operators shall receive initial training in the following topics:

5T1) UTruck Related Training TopicsU:

a. Operating instructions, warnings, and precautions for the types of trucks the operator will be authorized to operate

b. Differences between the operation of a PIT and automobiles

c. Truck controls and instrumentation: where they are located, what they do, and how they work

d. Engine or motor operation

e. Steering and maneuvering

f. Visibility (including restrictions due to loading)




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g. Fork and attachment adaptation, operation, and use limitations

h. Vehicle capacity

i. Vehicle stability

j. Any vehicle inspection and maintenance that the operator will be required to perform

k. Refueling and/or charging and recharging of batteries

l. Operating limitations

m. Any other operating instructions, warnings, or precautions listed in the operator's manual for the types of vehicle that the employee is being trained to operate.

5T2) UWorkplace-related topicsU5T:

a. Surface conditions where the vehicle will be operated

b. Composition of loads to be carried and load stability

c. Load manipulation, stacking, and unstacking

d. Pedestrian traffic in areas where the vehicle will be operated

e. Narrow aisles and other restricted places where the vehicle will be operated

f. Hazardous (classified) locations where the vehicle will be operated

g. Ramps and other sloped surfaces that could affect the vehicle's stability

h. Elevated surfaces such as docks.

i. Closed environments and other areas where insufficient ventilation or poor vehicle maintenance could cause a buildup of carbon monoxide or diesel exhaust

j. Other unique or potentially hazardous environmental conditions in the workplace that could affect safe operation

iv) Refresher TrainingS




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Shall be conducted annually to ensure that the operator has the knowledge and skills needed to operate the powered industrial truck.

a. At a minimum refresher training shall include internal or external classroom training utilizing media such as powerpoint, videos and case study examples that cover incidents and near miss activity that reflect the hazards in the facility.

v) Evaluations and Training

An evaluation of the effectiveness of the training shall be conducted which includes a road course simulating actual working conditions. Evaluations are to take place initially after completing training and a written evaluation (see Sample Attachment D), addition when:

a. The operator has been observed to operate the vehicle in an unsafe.

b. The operator has been involved in an accident or near miss-accident.

c. The operator has received an evaluation that reveals that the operator is not operating the truck safely.

d. The operator is assigned to drive a different type of truck

e. A condition in the workplace changes in a manner that could affect safe operation of the truck.

f. Once every 3 years the operator shall be evaluated for each type of vehicle they operate.

g. The evaluation should determine whether a PIT operator has the visual, physical and mental abilities to operate a vehicle safely within the confines and hazards associated within the workplace operations. If the PIT operator does not demonstrate the ability to fully master all aspects of the evaluation, then a license or license renewal shall not be granted to the operator. Necessary corrective action steps must first be initiated and demonstrated before a reevaluation is considered.

c) Safe Operating Procedures (SOP) and Rules

i) Only authorized and trained personnel will operate PIT's.




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ii) All PIT's will be equipped with overhead protection. Sit-down trucks will be equipped with seat belts if available from the manufacturer. Seat belts will be worn at all times by the Operator.

iii) The operator will perform daily pre-use inspections.

iv) Any safety defects (such as hydraulic fluid leaks; defective brakes, steering, lights, or horn; and/or missing lights or seat belts) will be reported for immediate repair, and the PIT will be taken "Out of Service" until repaired.

v) Operators will follow the proper recharging or refueling safety procedures.

vi) Loads will be tilted back and carried no more than 6 inches from the ground or high enough to clear obstructions, whichever is less. Loads that restrict the operator's vision will be transported with the load trailing.

vii) PIT's used indoors will travel no faster than 3 – 5 mph roughly the speed of a normal walk. S

viii) Operator will sound the horn and use extreme caution when meeting pedestrians, making turns and cornering.

ix) Passengers may not ride on any portion of a PIT. Only the operator will ride PIT’s.

x) If PIT’s are used as a manlift, an appropriate manlift platform (cage with standard rails, back guard and toe-boards) will be used. The PIT will not be moved more than what is required for final positioning with personnel in the platform. An operator must remain in the seat at all times while personnel are raised in the platform.

xi) Aisles are identified, shall be kept clear with no obstruction across or in the aisles that could create a hazard and aisles are wide enough for vehicle operation.

xii) Name plates, including capacity, will be legible on all PIT’s and will not be painted over. Operator will assure load does not exceed rated weight limits.

xiii) When un-attended, PIT’s will be turned off, forks lowered to the ground and parking brake applied.

xiv) Operators are instructed to report all accidents, regardless of fault and severity, to Management. Management will conduct an accident investigation.




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xv) When loading rail cars and trailers, dock plates will be used. Operators will assure dock plates are in good condition. Portable dock plates will be stored on edge when not in use.

xvi) Rail cars and trailers will be parked squarely to the loading area and have wheels chocked in place or dock locks engaged. Operators will follow established Docking/Un-Docking Procedures.

xvii) Trailer Jacks will be used on all trailers when the trailer is disconnected from the tractor for loading.

d) Changing and Charging Storage Batteries

i) Battery charging installations shall be located in areas designated for that purpose.

ii) Facilities shall be provided for flushing and neutralizing spilled electrolyte, for fire protection, for protecting charging apparatus from damage by trucks, and for adequate ventilation for dispersal of fumes from gassing batteries.

iii) An eye wash and shower must be provided along with wearing proper PPE including chemical resistant gloves, acid apron, eyewear and face protection are required before opening the lid of a battery.

iv) When handling batteries material handling assists shall be provided such as a conveyor, overhead hoist, or equivalent-material handling equipment.

v) Reinstalled batteries shall be properly positioned and secured in the truck.

vi) A carboy tilter or siphon shall be provided for handling electrolyte.

vii). Only add water to batteries when they aren’t being charged.

viii) Trucks shall be properly positioned and brakes applied before attempting to change or charge batteries.

ix) Care shall be taken to assure that vent caps are functioning.

x) Smoking is prohibited in the charging area.

xi) Precautions shall be taken to prevent open flames, sparks, or electric arcs in battery charging areas.

xii) Tools and other metallic objects shall be kept away from the top of uncovered batteries.




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e) Trucks and Railroad Cars

i) The flooring of trucks, trailers, and railroad cars shall be checked for breaks and weakness before they are driven onto.

ii) The brakes of highway trucks shall be set and wheel chocks placed under the rear wheels or dock locks engaged to prevent the trucks from rolling while they are boarded with powered industrial trucks.

iii) Wheel stops or other recognized positive protection shall be provided to prevent railroad cars from moving during loading or unloading operations.

iv) Fixed jacks will be necessary to support a semitrailer and prevent upending during the loading or unloading when the trailer is not coupled to a tractor.

v) Positive protection shall be provided to prevent railroad cars from being moved while dockboards or bridge plates are in position.

vi) Siding switches will be “blue flagged” during loading or unloading of rail cars.

f) Operations

i) If at any time a powered industrial truck is found to be in need of repair, defective, or in any way unsafe, the truck shall be taken out of service until it has been restored to safe operating condition.

ii) Trucks shall not be driven up to anyone standing in front of a bench or other fixed object.

iii) No person shall be allowed to stand or pass under the elevated portion of any truck, whether loaded or empty.

iv) No person shall be allowed to stand within ten feet of a load being placed in or removed from a rack, unless there is a physical stop in place designed to prevent the load from falling.

v) No person shall get within 3 feet of a forklift that is in operation.

vi) Unauthorized personnel shall not be permitted to ride on powered industrial trucks.




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vii) Arms or Legs shall not be placed between the uprights of the mast or outside the running lines of the truck.

viii) When a powered industrial truck is left unattended, load engaging means shall be fully lowered, controls shall be neutralized, power shall be shut off, and brakes set. Wheels shall be blocked if the truck is parked on an incline.

ix) A safe distance shall be maintained from the edge of ramps or platforms while on any elevated dock, or platform or freight car. Trucks shall not be used for opening or closing freight doors.

x) There shall be sufficient headroom under overhead installations, lights, pipes, sprinkler system, etc.

xi) An overhead guard shall be used as protection against falling objects. It should be noted that an overhead guard is intended to offer protection from the impact of small packages, boxes, bagged material, etc., representative of the job application, but not to withstand the impact of a falling capacity load.

xii) A load backrest extension shall be used whenever necessary to minimize the possibility of the load or part of it from falling rearward.

xiii) Trucks shall not be parked so as to block fire aisles, access to stairways, or fire equipment.

g) Traveling

i) All traffic regulations shall be observed, including authorized speed limits. A safe distance shall be maintained approximately three truck lengths from the truck ahead, and the truck shall be kept under control at all times.

ii) The right of way shall be yielded to ambulances, fire trucks, or other vehicles in emergency situations.

iii) Other trucks traveling in the same direction at intersections, blind spots, or other dangerous locations shall not be passed.

iv) The driver shall be required to slow down and sound the horn at cross aisles and other locations where vision is obstructed. If the load being carried obstructs forward view, the driver shall be required to travel with the load trailing.

v) Railroad tracks shall be crossed diagonally wherever possible. Parking closer than 8 feet from the center of railroad tracks is prohibited.




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vi) The driver shall be required to look in the direction of, and keep a clear view of the path of travel.

vii) Grades shall be ascended or descended slowly. When ascending or descending grades in excess of 10 percent, loaded trucks shall be driven with the load upgrade. On all grades the load and load engaging means shall be tilted back, if applicable, and raised only as far as necessary to clear the road surface.

viii) Under all travel conditions, the truck shall be operated at a speed that will permit it to be brought to a stop in a safe manner.

ix) Stunt driving and horseplay shall not be permitted.

x) The driver shall be required to slow down for wet and slippery floors.

xi) Dockboard or bridgeplates shall be properly secured before they are driven over. Dockboard or bridgeplates shall be driven over carefully and slowly and their rated capacity never exceeded.

xii) Running over loose objects shall be avoided.

xiii) While negotiating turns, speed shall be reduced to a safe level. Turns shall be negotiated by means of turning the hand steering wheel in a smooth, sweeping motion. Except when maneuvering at a very low speed, the hand steering wheel shall be turned at a moderate, even rate.

h) Loading

i) Only stable or safely arranged loads shall be handled. Caution shall be exercised when handling off-center loads that cannot be centered.

ii) Only loads within the rated capacity of the truck shall be handled.

iii) The long or high (including multiple-tiered) loads, which may affect capacity, shall be adjusted.

iv) Trucks equipped with attachments shall be operated as partially loaded trucks when not handling a load. The nameplate should reflect the reduction in capacity caused by the attachment.

v) A load-engaging means shall be placed under the load as far as possible; the mast shall be carefully tilted backward to stabilize the load.

vi) Extreme care shall be used when tilting the load forward or backward, particularly when high tiering. Tilting forward with load-engaging means elevated shall be prohibited except to pick up a load. An elevated load




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shall not be tilted forward except when the load is in a deposit position over a rack or stack. When stacking or tiering, only enough backward tilt to stabilize the load shall be used.

i) Fueling Safety

i) Fuel tanks shall not be filled while the engine is running. Spillage shall be avoided.

ii) Spillage of oil or fuel shall be carefully wiped up or completely evaporated and the fuel tank cap replaced before restarting the engine.

iii) No truck shall be operated with a leak in the fuel system until the leak has been corrected.

iv) Open flames shall not be used for checking electrolyte levels in storage batteries or gasoline level in fuel tanks.

j) Maintenance of Powered Industrial Trucks

i) Any power-operated industrial truck not in safe operating condition shall be removed from service. All repairs shall be made by authorized personnel.

ii) Those repairs to the fuel and ignition systems of industrial trucks that involve fire hazards shall be conducted only in locations designated for such repairs.

iii) Trucks in need of repairs to the electrical system shall have the battery disconnected prior to such repairs.

iv) All replacement parts shall be equivalent -- as to safety -- with those used in the original design.

v) Industrial trucks shall not be altered so that the relative positions of the various parts are different from what they were when originally received from the manufacturer. Nor shall they be altered either by the addition of extra parts not provided by the manufacturer or by the elimination of any parts. Additional counter-weighting of fork trucks shall not be done unless approved by the truck manufacturer.

vi) No welding to or drilling of any parts, including forks and overhead protection, shall be done without written approval from the manufacturer.




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vii) Industrial trucks shall be examined before being placed in service, and shall not be placed in service if the examination shows any condition adversely affecting the safety of the vehicle. Such examination shall be made at least daily. Where industrial trucks are used on an "around the clock" basis, they shall be examined prior to use each shift. Defects, when found, shall be immediately reported and corrected.

viii) When the temperature of any part of any truck is found to be in excess of its normal operating temperature, thus creating a hazardous condition, the vehicle shall be removed from service and not returned to service until the cause for such overheating has been eliminated.

ix) Industrial trucks shall be kept in a clean condition, free of lint, excess oil, and grease. Noncombustible agents should be used for cleaning trucks. Low flash point (below 100 deg. F.) solvents shall not be used. High flash point (at or above 100 deg. F.) solvents may be used.

k) Safe Operation Procedure for Charging LPG Tank

i) No Smoking.

ii) When possible, move LPG PIT outside for refueling.

iii) Turn off PIT.

iv) LPG tanks will be removed in the following order: 1) Shut off service valve 2) Disconnect tank from hose 3) Unbuckle and remove tank from bracket

v) PG tanks will be replaced in the following order: 1) Place tank in bracket and re-buckle 2) Reconnect hose to tank and tighten firmly 3) Open valve slowly and assure proper seal

NOTE: Federal Law Prohibits dispensing an improper fuel into any Vehicle or into a non-approved fuel container.

vi) In Case of LPG Leaks or Tank Rupture

1) DO NOT start or move the PIT.

2) If fuel hose is leaking, CLOSE valve immediately and place PIT "Out of Service" until repaired.




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3) If tank ruptures, warn others; immediately leave the area (at least 50 feet away); and notify Management. Do not re-enter the area until cleared by Management.

6) REVISIONS It is the responsibility of the Schneider Electric North America – Safety & Environmental department to review this policy and initiate revisions when necessary. It shall be reviewed no less than every three years.

7) REVISION CONTROL Revision Level

Date Issued

Reason for Change

New 10/18/11 Updated the format using the SE180A template and standardized the procedure for use throughout North America for the Safety and Environmental Team.


Procedure Number: SE 480 Attachment B

PAGE: 1 of 3

NAME: Power Industrial Truck –Training Outline Rev Date: 10/18/2011

PRINTED DOCUMENT IS UNCONTROLLED

Sample Document I. UIntroduction

a. Overview of the program b. Goal of the program: to provide a training program based on the trainee's

prior knowledge, the types of vehicles used in the workplace, and the hazards of the workplace.

c. Course will utilize video, group discussion and hands-on practice. Each operator must obtain the knowledge and skills needed to do their job correctly and safely.

II. UTypes, Features, and Physics

a. Familiarize each operator with the basic types and functions of powered industrial trucks.

b. Develop an understanding of the information shown on a data plate. c. Understand the critical truck measurements that affect safety. d. Understand the forces that cause tip-overs, and the truck design

considerations and safety ratings that help prevent them, including the "stability triangle."

III. UInspecting the Vehicle

a. Understand the purpose and importance of pre-operational checkouts. b. Provide a basic understanding of areas covered during a pre-operational

checkout. c. Familiarize each operator with a checklist for pre-operational checkouts, and

what to do if a problem is discovered. IV. UDriving the Truck

a. Understand the elements of safe movement of a powered industrial truck. b. Understand the differences between an automobile and a powered industrial

truck. c. Recognize the safety hazards associated with operating a powered industrial.

V. ULoad Handling

a. Understand the elements of load lifting safety.



PAGE: 2 of 3



b. Understand the safe operating procedures for raising and lowering loads in aisles.

VI. ULPG for Lift Trucks

a. Discuss LPG and its properties. b. Understand the elements and procedures of safely refueling internal

combustion vehicles. c. Describe tank components: service valve, surge valve, relief valve, etc. d. Discuss related safety issues.

VII. UBattery and Charging

a. Understand the elements and procedures of safely changing and charging batteries.

b. Discuss filling procedures and maintenance. c. Discuss related safety issues.

VIII. USafety Concerns

a. Review/reinforce potential of serious injury b. Review/reinforce safety procedures in your facility. c. Review Common Hazards

1. Falling loads 2. Overloading of equipment 3. Impact with equipment 4. Piercing of containers 5. Loading dock roll off 6. Chemical contact with battery acid 7. Fires during refueling

d. Review Methods to Control/Reduce Hazards

1. Control of equipment keys 2. Authorized fueling and recharge areas 3. Proper palletizing of material 4. Marked travel lanes 5. Equipment warning lights 6. Seat belts 7. Mounted fire extinguishers 8. Counter-balanced dock plates and ramps



PAGE: 3 of 3



9. Dock-locks and/or wheel chocks 10. Trailer jacks 11. Guardrails on non-working sides of ramps and docks

IX. USpecific Truck and Workplace Training/Hands-On

a. Review features of specific Powered Industrial Trucks (PITs) to be operated. b. Review operating procedures of specific PITs to be operated. c. Review safety concerns of specific PITs to be operated. d. Review workplace conditions and safety concerns of areas where PITs will be

operated. e. Learn/practice actual operation of specific PITs to be operated and specific

workplace conditions where PITs will be operated. f. Demonstrate proficiency performing the powered industrial truck operator's

duties specific to the trainee's position and workplace conditions.


Procedure Number: SE 480 Attachment C

PAGE: 1 of 1

NAME: Power Industrial Truck –License Certification Rev Date: 10/18/2011


Sample Document

1TName __________________________ Department ____________________________1T 1TSelection Criteria I certify that I meet all of the following physical qualifications and that if any changes to my physical condition develop, or if I no longer possess a valid State Drivers License, I will inform my supervisor within 24 hours:

• No adverse vision problems that are not corrected by glasses or contacts • No adverse hearing problems that are not corrected by hearing aids • No physical disorders that would impair safe operation • No medication is being taken that will affect perception, vision, or physical abilities.

Employee Signature: _____________________________________________

1TClassroom Training 1TReview Legal Requirements S 1TSafe Operating Procedures 1TLoad Handling & Vehicle Inspections 1TRefueling / Recharge Procedure 1TSpecial Environments 1TStability & Control 1TFuel Spill / Battery Acid Spill Procedure 1TSafety around pedestrians 1TTrainer Signature: 1TDate:

1THands On Training & Evaluation Rating: 1=Poor 2=Fair 3=Good 4=Excellent

1TGrade 1TArea of Evaluation 1TGrade 1TArea of Evaluation Familiar with controls Travels with load at proper height Slows at intersections Lowers load smoothly and slowly Sounds horn at intersections Load is properly balanced Obeys Signs Smooth start and stop Plans route, checks doorways Moves forks properly Proper cornering and turning Dock plate inspection Proper Refueling Yields to pedestrians Places/stacks load square and even Drives forward under control Drives backward under control Parks properly - neutralizes controls Proper approach to loads Maneuvers with load properly Lifts load properly Properly changes and charges battery Maintains clear view Drives on ramps

1TAdditional training is required for all areas graded as Fair or below 1TEvaluator Signature 1TDate:

1TCertification 1TWritten Exam Grade / Date 1T/ 1TQualified - Safety Manager Signature


Procedure Number: SE 480 Attachment D

PAGE: 1 of 6

NAME: Power Industrial Truck – Operator Written Evaluation Record

Rev Date: 10/18/2011


Sample Document Written Evaluation: Total Possible Points: 50 Note: Minimum Passing Score of 80% is Required. Employee's Name (Please Print): ______________________________________ Employee's Signature: ______________________________________________ Date: __ __ / __ __ / __ __ Practical Evaluation: The employee named above has successfully completed a practical driving evaluation and is now authorized to operate the powered industrial truck(s) as listed below. Instructor's Signature: ______________________________________________ Date __ __ / __ __ / __ __ WRITTEN TEST Questions (Answer by Circling True or False. If the statement is false, correct it to make it true). 1. T F Only employees authorized by completing Schneider Electric training shall

operate a Schneider Electric powered industrial truck on our property.

2. T F The safety checklist must be completed at the beginning of every work

shift. 3. T F Battery water levels should be checked and noted once per month. 4. T F The truck should always be driven forward. 5. T F When carrying a load, the forks should be raised to approximately 12”



PAGE: 2 of 6


Rev Date: 10/18/2011


and in the extended position. 6. T F When loading and unloading material into the racks, everyone within 20ft

should be notified. 7. T F Pedestrians have the right-of-way. 8. T F No person should be allowed to walk under raised forks. 9. T F Horns are to be used to gain a pedestrian’s attention. 10. T F An operator may exceed the rated load of the truck as long as the truck

does not tip. 11. T F Fork extensions are required for all pallets 60” and greater. 12. T F It is the tractor trailer operator's responsibility to ensure that the dock plate

is locked and the tires chocked. 13. T F It is permissible to block an isle way, emergency exit, or fire extinguisher for

a short time. 14. T F People may be transported using fork trucks. 15. T F Incidents should always be reported to the area Supervisor and SH&E. Complete the Following: 16. Describe how the load center affects the truck's rated capacity. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 17. What is the #1 cause of forklift truck accidents? ___ a) Operator Error ___ b) Unauthorized Use of Equipment ___ c) Faulty Equipment ___ d) Warehouse Design



PAGE: 3 of 6


Rev Date: 10/18/2011


18. List three (3) similarities and differences between an industrial powered truck and

an automobile: USimilaritiesU UDifferences 1) 1) 2) 2) 3) 3) 19. Define the term "Rated Capacity". ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 20. Who is authorized to determine what this capacity is? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ For question #21 use the following equation:

LC = (MWR x RLC) / NLC

where LC = Load Capacity MWR = Maximum Weighted Rate RLC = Rated Load Center NLC = New Load Center

21. Can a counter-balanced powered industrial truck rated at 4,000 lbs. at 24” to the

center of the forks lift a 72” pallet weighing 2,000 lbs.? (Show your work)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



PAGE: 4 of 6


Rev Date: 10/18/2011


22. Can a PIT, with the same rating, lift a 92” pallet weighing 2,000 lbs.? (Show your work) ________________________________________________________________________________________________________________________________________________________________________________________________________________________ 23. Name four factors that determine the stability of your truck. 1) 2) 3) 4) 24. List five steps to pick-up a load from the racks safely. 1) 2) 3) 4) 5) 25. Describe the position of the forks when transporting material.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

26. Describe the position of the forks when the truck is stopped and unattended. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 27. When should fork extensions be used? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



PAGE: 5 of 6


Rev Date: 10/18/2011


28. Why is the daily inspection required? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 29. Who must fill this out? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 30. Who should be notified if a problem or concern is revealed? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 31. What Personal Protective Equipment is required when checking the water level in the battery operated trucks? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 32. Describe the steps involved when checking the water level in the battery. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 33. When should this level be checked? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



PAGE: 6 of 6


Rev Date: 10/18/2011


34. What four (4) things must the operator do when parking the truck? 1) 2) 3) 4) 35. What is the proper operation of any industrial truck on a slope? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 36. When is fall protection required when operating a truck? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 37. What is the most significant factor in determining the safety of moving materials

throughout the plant? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 38. Who is primarily responsible for safe truck operations? ________________________________________________________________________________________________________________________________________________


Procedure Number: SE480 Attachment E

PAGE: 1 of 5

NAME: Operator Evaluation Answer Key Rev Date: 10/18/2011


Powered Industrial Truck Training Written Evaluation: Total Possible Points: 50 Note: Minimum Passing Score of 80% is Required. Employee's Name (Please Print): ANSWER SHEET Employee's Signature: ______________________________________________ Date: __ __ / __ __ / __ __ Practical Evaluation: The employee named above has successfully completed a practical driving evaluation and is now authorized to operate the powered industrial truck(s) as listed below. Instructor's Signature: ______________________________________________ Date __ __ / __ __ / __ __ WRITTEN TEST Questions (Answer by Circling True or False. If the statement is false, correct it to make it true). 1. T F Only employees authorized by completing Schneider Electric training shall

operate a Schneider Electric powered industrial truck on our property.

2. T F The safety checklist must be completed at the beginning of every work

shift. 3. T F Battery water levels should be checked and noted once per month. Once

per week.



PAGE: 2 of 5



4. T F The truck should always be driven forward. 5. T F When carrying a load, the forks should be raised to approximately 12”

and in the extended position. Maximum 6” 6. T F When loading and unloading material into the racks, everyone within 20

feet should be notified. 10 feet

7. T F Pedestrians have the right-of-way. 8. T F No person should be allowed to walk under raised forks. 9. T F Horns are to be used to gain a pedestrian’s attention. 10. T F An operator may exceed the rated load of the truck as long as the truck

does not tip. 11. T F Fork extensions are required for all pallets 60” and greater. Unless forklift

has been modified with extended forks. 12. T F It is the tractor trailer operator's responsibility to ensure that the dock plate

is locked and the tires chocked. It is the forklift operator’s responsibility.

13. T F It is permissible to block an isle way, emergency exit, or fire extinguisher for

a short time. 14. T F People may be transported using fork trucks. 15. T F Incidents should always be reported to the area Supervisor and SH&E. Complete the Following: 16. Describe how the load center affects the truck's rated capacity. An increase in the length of a load center will result in a decrease in a truck’s rated capacity. 17. What is the #1 cause of forklift truck accidents? X a) Operator Error



PAGE: 3 of 5



___ b) Unauthorized Use of Equipment ___ c) Faulty Equipment ___ d) Warehouse Design 18. List three (3) similarities and differences between an industrial powered truck and

an automobile: USimilaritiesU UDifferences 1) Horn, brakes, accelerator 1) Weight 2) Similar steering on sit-down lifts 2) Rear Steering, Suspension 3) Four tires (some models) 3) Automobiles don’t carry heavy loads 19. Define the term "Rated Capacity". The maximum amount of weight that a P.I.V. can safely lift as defined by the Manufacturer given a specified load center and maximum lifting height. 20. Who is authorized to determine what this capacity is? The Manufacturer of the P.I.V. For question #21 use the following equation:

LC = (MWR x RLC) / NLC

where LC = Load Capacity MWR = Maximum Weighted Rate RLC = Rated Load Center NLC = New Load Center

21. Can a counter-balanced powered industrial truck rated at 4,000 lbs. at 24” to the

center of the forks lift a 72” pallet weighing 2,000 lbs.? (Show your work)

72” load = 36” load center 4000 lb X 24” LC / 36” = 96000 / 36 = 2667 lbs New Capacity Rating Since the New Rated Capacity of the truck is 2667 lbs, it can safely lift the 2000 lb. load. 22. Can a PIT, with the same rating, lift a 92” pallet weighing 2,000 lbs.? (Show your work) 92” load = 46” load center 4000 lb X 24” LC / 46” = 96000 / 36 = 2086 lbs New Capacity Rating



PAGE: 4 of 5



Since the New Rated Capacity of the truck is 2086 lbs, it can safely lift the 2000 lb. load. 23. Name four factors that determine the stability of your truck. 1) Load center of load 2) Weight of load, Height of load 3) Surface conditions 4) Design of truck (i.e. wheel base) 24. List five steps to pick-up a load from the racks safely. 1) Determine the weight of the load. Ensure that it is within the rated capacity of P.I.V. 2) Adjust the width of the forks to the load. 3) Approach the load slowly, watching carefully for pedestrian or other obstructions. 4) Slowly lift load from surface and verify that the load remains stable. 5) Tilt the fork back so that the load rests against the mast. 25. Describe the position of the forks when transporting material. As close to the ground as possible to safely clear uneven surfaces, etc. (Not more than 6” off the ground). 26. Describe the position of the forks when the truck is stopped and unattended. Lower forks to floor and tilt them flat. 27. When should fork extensions be used? Whenever the load is greater than 60” long and the forklift has not been modified with extended forks. 28. Why is the daily inspection required? To ensure that the P.I.V. is safe to operate and does not have any mechanical or operation malfunctions. 29. Who must fill this out? The operator of the truck must ensure that the daily inspection has been completed for the shift. 30. Who should be notified if a problem or concern is revealed? Supervisor, SH&E and/or Maintenance Dept.



PAGE: 5 of 5



31. What Personal Protective Equipment is required when checking the water level in the battery operated trucks? Face shield, chemical resistance gloves and apron (unless P.I.V. has self filling reservoir). 32. Describe the steps involved when checking the water level in the battery. Ensure that the battery is fully charged and disconnected from the charger; Put on proper P.P.E. 33. When should this level be checked? Once per week. 34. What four (4) things must the operator do when parking the truck? 1) Lower forks to floor and tilt them flat. 2) Put controls in neutral. 3) Set parking brake. 4) Take the key. 35. What is the proper operation of any industrial truck on a slope? Reverse going down the slope; Forward going up the slope. The load should always be upgrade. 36. When is fall protection required when operating a truck? Whenever the operator is more than 4’ off the ground. 37. What is the most significant factor in determining the safety of moving materials

throughout the plant? The attention of the operator to observe all safe operator practices. 38. Who is primarily responsible for safe truck operations? The operator of the P.I.V.


Procedure Number: SE 480 Attachment A

PAGE: 1 of 1

NAME: Power Industrial Truck – Pre-use inspection checklist

Rev Date: 10/18/2011


Sample Document Elements needed in your PIT pre-use checklist

A check of the following items (as applicable) is to be conducted by the operator prior to use each shift.

Lights Horn Brakes Leaks Fork/Mast Condition Overhead Guard Condition Control Operation Steering Operation Warning Beacon Backup Warning Alarm Fire Extinguisher

If any deficiencies are noted, the unit is to be placed OUT OF SERVICE until the problem has been corrected. Additionally, it is the operator’s responsibility to notify the immediate supervisor and fill out a maintenance request.

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