Aerial Lift Operator Job Performance Measure Form
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1
2Aerial Lift Operator Job Performance Measure (TQ-AERIAL-P)
Candidate Name ([Print):
Life/Guest/Contractor Number
Department/Division
Evaluator Name ([Print):
Date JPM Completed
Bldg. Number where JPM Performed
Prerequisite Information
Prerequisites and practice/observation activity must be completed before job performance measure is administered.
GE-FALLPROTECT
TQ-AERIAL-C or TQ-AERIAL-W
________________________________
___________________________________
Classroom Fall Protection Course Completion Date
Aerial Lift Operator Course Completion Date
Practice or observation activity verified by: __________________________________
OJT Instructor
Review of Manufacturer’s Manual:
The evaluator identified above or the candidate’s supervisor verifies that the above-named candidate has read the
applicable Manufacturer’s Operating Manual. This reading task is a prerequisite requirement to all subsequent hands-on
training and evaluation activities.
New Operator Hands-on Training:
The evaluator identified above verifies that the subject candidate (new operator) has been provided with hands-on
training and practice time with direct supervision of a qualified operator or trainer/examiner and has demonstrated
satisfactory competence in the standards and performance measures prescribed by this checklist.
Total hands-on training hours: ______. Administer the JPM.
Incumbent Operator Competence/Proficiency:
The evaluator identified above or the candidate’s supervisor, identified on the back of this form, has observed the above-
named candidate (incumbent operator) operating the specified aerial device/s performing routine work on multiple
occasions in a competent and proficient manner.
Approximate total observation hours: ______. Administer the JPM.
Equipment Qualifications
Aerial Platform Manufacturer: _______________________________ Model: _____________ Maximum Capacity: ______
Note: Qualification on one ANSI/SIA aerial platform classification qualifies the operator for all additional devices that have
shorter boom lengths, extensions or elevating height and similar operating characteristics within the below groupings,
provided that the manufacturer’s applicable manual has been read
.
Mark those successfully demonstrated.
Max
Type
Elevating
Aerial
Qualification
Boom
Propulsion
Mechanism
ANSI/SIA
Device
Codes
Length/
Standard
Description
Manual
IC
DC
Hydraulic
Air
Elec
Extend
A92.2, 2000
Vehicle-Mtd Elevating & Rotating Platform
TQ-AERIAL-VM-25
25’
A92.2, 2000
Vehicle-Mtd Elevating & Rotating Platform
TQ-AERIAL-VM-45
45’
A92.2, 2000
Vehicle-Mtd Elevating & Rotating Platform
TQ-AERIAL-VM-65
65’
A92.3, 1990
Manually-Propelled Elevating Platform
TQ-AERIAL-MP-20
20’
A92.3, 1990
Manually-Propelled Elevating Platform
TQ-AERIAL-MP-30
30’
A92.3, 1990
Manually-Propelled Elevating Platform
TQ-AERIAL-MP-40
40’
A92.5, 1992
Boom-Supported Elevating Work Platform
TQ-AERIAL-BS-40
40’
A92.5, 1992
Boom-Supported Elevating Work Platform
TQ-AERIAL-BS-50
50’
A92.5, 1992
Boom-Supported Elevating Work Platform
TQ-AERIAL-BS-90
90’
A92.5, 1992
Boom-Supported Elevating Work Platform
TQ-AERIAL-BS-125
125’
A92.6, 1999
Self-Prop Elevating Work Platforms, Vertical
20’
TQ-AERIAL-VP-20
A92.6, 1999
Self-Prop Elevating Work Platforms, Vertical
TQ-AERIAL-VP-40
40’
A92.6, 1999
Self-Prop Elevating Work Platforms, Vertical
60’
TQ-AERIAL-VP-60
Submit form to Training in Building 400 for individuals who have successfully completed this Job Performance Measure.
Rev: 29 March 2011
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