<table>
<colgroup>
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<tbody>
<tr class="odd">
<td colspan="12"><p><strong>EQUIPMENT OPERATOR SKILLS TEST</strong></p>
<p><strong>(CRANE-HYDRAULIC)</strong></p></td>
</tr>
<tr class="even">
<td colspan="5">Name:</td>
<td colspan="2">SSN/ID No.:</td>
<td colspan="5">Date of Test</td>
</tr>
<tr class="odd">
<td colspan="12">Project Name &amp; Number</td>
</tr>
<tr class="even">
<td colspan="2">Manufacturer:</td>
<td colspan="3">Model:</td>
<td colspan="2">Serial No.:</td>
<td colspan="5">Capacity:</td>
</tr>
<tr class="odd">
<td colspan="2">Boom Length</td>
<td colspan="4">Crane Type (check one)</td>
<td colspan="2">Was Operator Licensed?</td>
<td> Yes</td>
<td colspan="3"> No</td>
</tr>
<tr class="even">
<td>Main:</td>
<td>JIB:</td>
<td colspan="4"> Crawler Truck Self-Propelled</td>
<td colspan="6">(If no, state reason on back of form)</td>
</tr>
<tr class="odd">
<td colspan="5">Operator’s Signature:</td>
<td colspan="7">Licensor’s Signature</td>
</tr>
<tr class="even">
<td colspan="12">Comments:</td>
</tr>
<tr class="odd">
<td colspan="12"><p>Notes:</p>
<p>1. Locate machine in the test area prior to beginning skills
test.</p>
<p>2. Exercise caution to ensure that test equipment is in a safe,
operable condition when furnished to an applicant for testing.</p>
<p>3. The operator is required to successfully pass the skills
test.</p></td>
</tr>
<tr class="even">
<td colspan="3">PRE-START INSPECTION</td>
<td>PASS</td>
<td>FAIL</td>
<td colspan="5">OPERATIONAL</td>
<td>PASS</td>
<td>FAIL</td>
</tr>
<tr class="odd">
<td colspan="3">1. Locate, check, and identify the following:</td>
<td></td>
<td></td>
<td colspan="5" rowspan="2"><p>4. Extend outrigger beams and level
machine</p>
<blockquote>
<p>Note: Tires should clear ground (excluding crawler cranes)</p>
</blockquote></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>A. Engine oil level</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>B. Coolant level</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="2">5. From the crane load charts using a 20-ft
radius<br />
(with outriggers extended), select:</td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>C. Hydraulic oil level</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>D. Brake fluid level N/A</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>A. Maximum capacity of the machine</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>E. Battery condition</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>B. Correct boom length</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>F. Fuel level</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>C. Correct boom length</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>G. Fluid leaks (oil, water)</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>D. Determination of net load weight</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>H. Safety equipment</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="2">6. Program LMI for crane configuration<br />
Note: Operator explains procedure</td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Posted load chart</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>Fire extinguisher (charged, mounted)</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5">7. Raise boom to a 45 degree angle</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Warning signs</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="2">8. Lower load block by proper hand
signal<br />
Note: Use ball if machine is not equipped with load block.</td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>Mirrors</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Seat belts (cut, worn)</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="2">9. Extend boom and hold block 5 ft from
ground on proper hand signal (until boom is fully extended)</td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>Glass condition (dirty, cracked, missing)</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>I. Tires (cuts, low, general condition) N/A</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="3">10. Swing boom 90 degrees on proper hand
signal<br />
Note: The operator should be rated on accuracy of smoothness of swing
and drift of ball or block</td>
<td rowspan="3"></td>
<td rowspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>J. Tracks and adjustment N/A</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>K. Wire rope and connections, proper spool of wire rope</p>
</blockquote></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>on drum</p>
</blockquote></td>
<td colspan="5" rowspan="3">11. With ball or block swinging
perpendicular to plane of Boom, operator stabilizes ball or block with
no more than 4 swing movements of boon</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>L. Belts (fan, air compressor, pumps)</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>M. Air cleaner indicator/dust ejector</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>N. Brakes:</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="7">12. Swing boom 180 degrees and place hook in
a 5-ft diameter circle at a 30-ft radius. (For machines with boom
lengths less than 30 ft, use a radius of 2/3 maximum radius)<br />
Note: Verbal instructions<br />
Note: Hook is maintained at a 10-ft height during swing and boom angle
adjustment; after hook has been lowered, no swing or boom angle
adjustments may be made</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>Parking</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Swing</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>O. House swing lock</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>P. Transmission and controls (in neutral position)</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>Q. Emergency engine shutdown</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3">POST-START INSPECTION</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3">2. A. Start engine</td>
<td></td>
<td></td>
<td colspan="5" rowspan="4"><p>13. Prepare machine for travel</p>
<p>Note: use seat belt and lights<br />
Note: The operator should be rated on boom retraction, boom placed over
front of machine, jacks and outrigger beams retracted, and swing lock
applied</p></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>B. Check all gauges for proper operation</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>C. Allow engine and hydraulic oil to warm up to operating temperature
and check for air and oil leaks</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>D. Check control functions</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>E. Check anti two-block activation</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5" rowspan="6">14. Travel machine a minimum of 100 ft. over
existing project roads, turn crane around and return to starting
point<br />
Note: Operator should demonstrate ability to use rear wheel
steering<br />
Note: the operator should be rated on application, coordination and
smoothness of throttle, brakes, and accuracy of steering</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>F. Check operation and/or set up LMI (load moment indicator)
system</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3">3. Check</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>A. Signal horn</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>B. Back-up alarm</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>C. Windshield wipers</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>D. Defrost fan</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5">RETURN, SHUT DOWN, AND SECURE</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>E. All lights</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5">15. Return all controls to neutral position</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>F. Warning beacon</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5">16. Set:</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>G. Brakes</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>A. Parking brakes</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><blockquote>
<p>H. Steering</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>B. Swing brake</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>I. Mirror for adjustments</p>
</blockquote></td>
<td></td>
<td></td>
<td colspan="5"><blockquote>
<p>C. House lock</p>
</blockquote></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="5">17. Idle engine for 2 minutes and shut down engine</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="5">18. Drain air tanks N/A</td>
<td></td>
<td></td>
</tr>
</tbody>
</table>