+---------------------------+----------------+------------------------+
| **CHAIN SAW OPERATOR      |                |                        |
| FIELD EVALUATION FORM     |                |                        |
| (date/version of form:    |                |                        |
| 04/05/05)**               |                |                        |
+---------------------------+----------------+------------------------+
| Name:                     | A              |                        |
|                           | gency/Employee |                        |
|                           | Address:       |                        |
+---------------------------+----------------+------------------------+
| Date:                     |                |                        |
+---------------------------+----------------+------------------------+
| Training Location:        | Phone:         | Email:                 |
+---------------------------+----------------+------------------------+
| Previous Certification?   |                |                        |
| Yes\_\_\_\_ No\_\_\_\_    |                |                        |
| Level                     |                |                        |
| \_\_\_\_\_\_\_\_\_\_      |                |                        |
| Agency/Unit               |                |                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |                |                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |                |                        |
| Year \_\_\_\_\_\_         |                |                        |
|                           |                |                        |
| **Note to Evaluator:** *A |                |                        |
| scale of 1 through 5 will |                |                        |
| be used to identify       |                |                        |
| proficiency in each area: |                |                        |
| 1 = Weak, 2 = Poor, 3 =   |                |                        |
| Satisfactory, 4 = Very    |                |                        |
| Good, 5 = Outstanding. 0  |                |                        |
| or N/A means trainee was  |                |                        |
| not evaluated in area or  |                |                        |
| Not Applicable. All       |                |                        |
| blanks must be filled in. |                |                        |
| Use \* & reference \# to  |                |                        |
| add supporting            |                |                        |
| information/explanation   |                |                        |
| in comments block*        |                |                        |
|                           |                |                        |
| **Notable safety          |                |                        |
| equipment deficiency will |                |                        |
| result in automatic       |                |                        |
| certification             |                |                        |
| disqualification.**       |                |                        |
+---------------------------+----------------+------------------------+

  ------------------- -------- ---------------- ----------- --- --- ----------------- ----------- --- --- -------------------
  **YES**             **NO**   **SAFETY         **SCORE**           **CHAIN SAW USE** **SCORE**           **HAZARD ANALYSIS**
                               EQUIPMENT**                                                                

                                                Tree \#                               Tree \#             

                                                1           2   3                     1           2   3   

                               Hard Hat                             Chain Saw & Axe                       Top
                                                                    Condition                             

                               Eye Protection                       Starting                              Widow Makers
                                                                    Procedure                             

                               Hearing                              Throttle Lock Use                     Bark
                               Protection                                                                 

                               Long Sleeved                         Correct Body                          Leaners
                               Shirt                                Position                              

                               Gloves                               Thumb Placement                       Hang-ups

                               Boots                                Bar Tip Use -                         Determine Soundness
                                                                    general                               & Lean(s)

                               Chaps                                Boring - specific                     Snag/Green Tree
                                                                                                          Hazards

                               Axe (3-5 lb)                         Chain Brake Use                       Root Wads/Loose
                                                                                                          Logs

                               Wedges                               Foot Travel with                      Wind
                               (appropriate)                        Chain Saw                             

                               Approved                             Chain Saw Tool                        Spring Poles
                               fuel/oil                             Kit                                   
                               container                                                                  

                                                                    Field Chain                           Disease/Fungus
                                                                    Sharpening                            

                                                                                                          Other (list)

  NOTE: Safety item                                                                                       
  deficiency will                                                                                         
  result in automatic                                                                                     
  certification                                                                                           
  disqualification.                                                                                       

                                                                                                          
  ------------------- -------- ---------------- ----------- --- --- ----------------- ----------- --- --- -------------------

  ----------- ------- ------- --------------------------- ----------- --- --- -----------------------------
  **SCORE**                   **LIMBING & BRUSHING**      **SCORE**           **BUCKING**

  Tree \#                                                 Trees               

  **1**       **2**   **3**                               1           2   3   

                              Overhead & Ground Hazard                        Overhead & Ground Hazard
                              Analysis                                        Analysis

                              Brief Swamper                                   Escape Route

                              Control Cutting Area                            Bind / Tension-Compression
                                                                              Analysis

                              Swamps out Work Area                            Swamps Out Work Area

                              Escape Route                                    Thumb Placement

                              Body Positioning                                Use of Wedge / Pie Cut

                              Thumb Placement                                 Cut Sequence

                              Use of Bar Tip                                  Kerf Observation

                              Avoids Over / Under                             Release Cut Movement
                              Reaching                                        

                              Power-head below Shoulder                       Multiple Bind Situations
                              Height                                          

                              Limb Removal Sequence                           Wedging Procedure

                              Spring                                          Spring Poles -Tension
                              Poles-Tension/Compression                       /Compression Analysis
                              Analysis                                        

                              Avoids Kickback                                 Avoids Kickback

                                                                              

                                                                              
  ----------- ------- ------- --------------------------- ----------- --- --- -----------------------------

  ------------- --- --- ---------------------------- ----------- --- --- ---------------------------
  **FALLING**                                                            

  **SCORE**             **FELLING AREA**             **SCORE**           **FELLING PROCEDURE**

  1             2   3                                1           2   3   

                        Saw Team Safety                                  Go / No Go Decision / Walk
                        Briefing/Communications                          Away

                        Establish/maintains secure                       Plumb Lean - Determines Lay
                        felling area (2.5)                               

                        Establish positive                               Escape Routes,
                        communication                                    Alternatives, Safety Zones

  **SCORE**             **STUMP ANALYSIS**                               Swamps out work area and
                                                                         escape routes

                        Felled to Desired/Other Lay                      Undercutting - Gunning or
                                                                         Horizontal Cut

                        Undercut Position                                Use of Gunning Sites

                        Sloping Cut Position                             Sloping Cut

                        Face Cut Angle                                   Warning Shout

                        Back Cut                                         Back Cut

                        Dutchman - one/both corners                      Cuts in upright position /
                                                                         Looks Overhead

                        Holding/Hinge Wood                               Procedure Alteration (if
                                                                         necessary)

                        Undercut as a Whole                              Wedging Procedure

                                                                         Use of Escape Route /
                                                                         Safety Zone

                                                                         

                                                                         
  ------------- --- --- ---------------------------- ----------- --- --- ---------------------------

+-----------------------+-----------------------+-----------------------+
| **EVALUATOR'S STUMP   |                       |                       |
| ANALYSIS SKETCHES**   |                       |                       |
+-----------------------+-----------------------+-----------------------+
| ##                    |                       |                       |
|                       |                       |                       |
| ##                    |                       |                       |
+-----------------------+-----------------------+-----------------------+
| **Tree 1**            | **Tree 2**            | **Tree 3**            |
|                       |                       |                       |
| Height                | Height                | Height                |
| \_\_\_\_\_\_\_\_\_\_  | \_\_\_\_\_\_\_\_\_\_  | \_\_\_\_\_\_\_\_\_\_  |
| DBH\                  | DBH\                  | DBH\                  |
| _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ |
|                       |                       |                       |
| \%                    | \%                    | \%                    |
| Sl                    | Sl                    | Sl                    |
| ope\_\_\_\_\_\_\_\_\_ | ope\_\_\_\_\_\_\_\_\_ | ope\_\_\_\_\_\_\_\_\_ |
| Species               | Species               | Species               |
| \_\_\_\_\_\_\_\_\_    | \_\_\_\_\_\_\_\_\_    | \_\_\_\_\_\_\_\_\_    |
|                       |                       |                       |
| Condition\_\_\_       | Condition\_\_\_       | Condition\_\_\_       |
| \_\_\_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ |
|                       |                       |                       |
| Feet from center of   | Feet from center of   | Feet from center of   |
| lay                   | lay                   | lay                   |
| \_\_\                 | \_\_\                 | \_\_\                 |
| _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_ |
+-----------------------+-----------------------+-----------------------+

**[COMMENTS: Attitude, Technical Skills, Verbal Skills Weak-Strong, etc.
(be specific)]{.underline}**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_RECOMMENDED
> SKILL LEVEL **circle one** - Apprentice (A), Intermediate (B),
> Advanced (C)

**RESTRICTIONS:** (if
any)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Classroom Instruction Given
At:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Instructor's
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Level\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Approved By: (Unit, Forest, Regional Manager)\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_ Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Leve\_\_\_\_\_\_\_\_

Field Examination Given
At:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Examiner's
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Level\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Examiner's
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Level\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Student
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_

Supervisor's
Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Title\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_