Crane Operator Skills Test/Performance Evaluation (Friction)

F0286

January 27, 2014

USGC GulfstreamProgramPage 1 of 1

The Dow Chemical Company

Name: / SSN/ID No.: / Date of Test:
Project Name: / Project No./Contract No.:
Manufacturer: / Model: / Serial No.: / Capacity:
Boom Length: / Crane Type (check one): / Was Operator Licensed? / Yes / No
Main: JIB: / Crawler / Truck / (If no, state reason on back of form)
Operator’s Signature: / Licensor’s Signature:
Comments:
Caution:Ensure that test equipment is in safe, operable condition when furnished to an applicant for testing.
Pre-Start Inspection / Pass / Fail / Operational / Pass / Fail
1. / Locate, check, and identify the following: / 4. / Extend outrigger beams and level machine
Note: Tires should clear ground
a.Engine oil level
b.Coolant level / 5. / Program load moment indicator for crane
configuration. Note: Operator explains procedure
c.Hydraulic oil level
d.Brake fluid level / N/A / 6. / Select from crane load chart maximum capacity of machine at50-foot radius (outriggers extended):
e.Battery condition
f.Fuel level / a.Maximum capacity of machine
g.Fluid leaks (oil, water) / b.Selection of correct boom length
h.Safety equipment: / c.Selection of correct boom angle
Operator’s manual; posted load chart / d.Determination of net load weight
Fire extinguisher (charged, mounted) / 7. / a.Raise headache ball and check brakes
Warning signs / b.Lower headache ball and check brakes
Mirrors / Note: Use load block, if machine is not
equipped with jib and ball
Seat belt (cuts, worn)
Glass condition (dirty, cracked, missing) / 8. / a.Boom down 10degrees
i.Tires (cuts, low, general condition) / N/A / b.Boom up 10degrees
j.Tracks and adjustment / N/A / 9. / Swing machine by proper hand signal
k.Wire rope and connections, proper spool of wire
rope on drum / Note: The operator should be rated on accuracy
of smoothness of swing and drift of ball or block
l.Belts (fan, air compressor, pumps) / 10. / Lift load with ball, swing, stop, and lower load
by proper hand signals
m.Air cleaner indicator/dust ejector
n.Brakes and dogs: / 11. / Lift load with ball:
Parking (travel) / a.Boom down and hold load 10feet off
ground by proper hand signals
Swing
Hoist / b.Boom up and hold load 10feet off ground
by proper hand signals
Boom
o.Transmission and controls (in neutral position or
master clutch disengaged) / 12. / Lower load to ground and disconnect load
13. / Swing boom and place hook in a 5foot
diameter circle at a 50foot radius for boom length up
to 150feet; 100foot radius for boom length greater
than 150feet
p.Emergency engine shutdown
Post-Start Inspection
2. / a.Start engine
b.Check all gauges for proper operation / Note: The operator should be rated on:
c.Allow engine and hydraulic oil to warm up tooperatingtemperature and check for air/oil leaks / Boom swing clearance
Counterweight swing clearance
d.Check control functions / Swing barricade
e.Check anti twoblock activation / 14. / Prepare machine for travel
f.Check operation of, or set up load momentindicatorsystem / Return, Shut Down, and Secure
15. / Return all controls to neutral position
3. / Check: / 16. / Set:
a.Signal horn/backup alarm / a.Parking brakes
b.Windshield wiper(s) / b.House lock
c.Defrost fan / c.Swing brake
d.All lights/warning beacon / d.Boom brakes/dog
e.Swing alarm / e.Hoist brakes/dog
f.Brakes / 17. / Idle engine for 5minutes and shut down engine
g.Steering / 18. / Drain air tanks / N/A
h.Mirrors for adjustment

Distribution: Original — Retained at project/site; Copy —Corporate HSE Training Department

Crane Operator Skills Test/Performance Evaluation (Friction)This is a controlled document. No un-authorized modifications.

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