<p> Form 000.653.F0298 Crane Operator Skills Test/Performance Evaluation (Tower)</p><p>Name: SSN/ID No.: Date of Test:</p><p>Project Name: Project No./Contract No.:</p><p>Manufacturer: Model: Serial No.: Capacity:</p><p>Jib Length: Fixed Jib Luffing Jib Was Operator Licensed? Mast Height: Yes No (state reason on back of form) Operator’s Signature: Licensor’s Signature:</p><p>Caution: Ensure that test equipment is in safe, operable condition when furnished to an applicant for testing. PRE-START INSPECTION PASS FAIL N/A COMMENT Locate and check master electrical disconnect switch 1. (for emergency shutdown use only). Check wire rope and connections, block, and distance markings along 2. boom; check swing clearance. 3. Check oil and hydraulic levels (gear-drive boxes). 4. Locate electrical stop bottom or switch. 5. Energize machine (start or turn on machine). 6. Check all operational limit switches. 7 Operator’s manual. </p><p>OPERATION 8. Check controls: a. Trolley out on signal. b. Hoist down on signal. c. Hoist up on signal. d. Swing on signal 90 degrees (left or right.) </p><p>Swing 180 degrees and place hook in a 3.05-meter (10-foot) diameter 9. circle at a 30.5-meter (100-foot) radius; check for smoothness and drift control. Return machine to store position and shut down according to 10. proper procedures.</p><p>Distribution Original — Retained at project/site Copy — Corporate HSE Training Department</p><p>Note: This form is referenced in Practice 000.653.3201.</p><p>Copyright © 2009, P2S. All Rights Reserved. Page 1 of 1 Health, Safety, and Environmental Form Date: 01May2009</p>