Crane Operator Practical Exam Examiner Observation Sheet

Transcription

1 Crane Operator Practical Exam Examiner Observation Sheet Observation sheet must be complete before a certification card can be issued. A. To be completed by the Practical Exam Coordinator on the day of exam. 1. Practical Exam Coordinator s Name 2. Coordinator ID# 3. Proctor s Name (if different) B. To be completed by Examiner in waiting area. All information is required per OSHA & state requirements. 4. Candidate s First Name (Legal) 5. MI (Legal) 6. Last Name (Legal) 7. Candidate ID# 8. Verify that Candidate s name and face match Confirmation and Government Photo ID: (Call CIC at ) 9. Crane Type (circle one): 10. Other Crane Type (if not listed): Mobile Crane: Multi-Purpose: 01) Telescoping Boom, wheeled 06) Articulating Boom Crane 02) Telescoping Boom, crawler 07) Digger Derrick Crane 03) Lattice Boom, carrier 08) Service/Mechanic Truck Crane 04) Lattice Boom, crawler 05) Lattice Boom, Friction Load Hoist 11. Crane Manufacturer 12. Model 13. Max. Capacity 14. Cab Type (circle one) 15. Practical exam capacity administered: 16. Boom Length Telescoping Boom during test: tons 1) Fixed (1) Small, Under 21 Tons (36 +/- 5 ) ft. tons 2) Rotating (2) Medium, Tons (75 +/- 5 ) ft. tons 3) Not Applicable (3) Large, Over 75 Tons (120 +/- 10 ) ft.. Lattice Boom tons (4) Carrier (120 +/- 10 ) ft. tons (5) Crawler (120 +/- 10 ) ft. tons (6) Service/Mechanic Truck (20 +/- 5 ) ft. (circle one) (circle one) C. 17. To be completed by Examiner during Candidate s Familiarization. All information required. Variances not permitted unless requested in writing. Pre-approval by CIC in writing must be included with this form. Approval Date: 18. Examiner s Name 19. # 20. Date 21. Time (00:00) Weather Conditions: 27. Equipment Variance: 30. Course Variance: 22. Are winds over 20 mph? 23. Lightning struck within 30 min.? 28. If yes, type of equipment 31. If yes, type of course variance: (circle one) variance: (circle one) 24. Is course visible? (i.e. heavy rain, fog 01) Short boom 01) Course altered or snow) 02) Other 02) Course reduced 03) Other Equipment Status: 29. Explain variance: 25. Crane is level: 32. Explain variance: 26. Pre-Operational Inspection: (1) Satisfactory (2) Unsatisfactory 33. Does test load exceed 25% of crane s rated capacity at longest radius (see PE Handbook)? My signature below confirms that I verified the above information at the time of the exam. 34. Examiner s Signature FOR OFFICE USE ONLY: 35. Date (mm/dd/yyyy) 2016 Crane Institute of America Certification, LLC. All rights reserved. Page: 1 of 4 Form: CO-EOS

2 Examiner Observation Sheet D. To be completed by Candidate after the Familiarization Period and prior to the Exam. (Allow time for the candidate to answer all questions completely) 36. I was given up to 15 minutes to familiarize myself with the crane and exam conditions. 37. My name and ID in Section B is correct. 38. I agree with the weather conditions and equipment status as indicated in Section C. 39. Comment on any No responses above. 40. I wish to take the Exam indicated in Section B at this time If the conditions allow for the exam and you do not wish to take the exam, you will forfeit your registration fee but may reapply at any time. By signing below, I state that the information above is accurate. Furthermore, I release my certification results to the individual who completed my registration, on my behalf. 41. Candidate s Signature: FOR OFFICE USE ONLY: 42. Date (mm/dd/yyyy) 43. Practical Exam Site Address: (REQUIRED) Practical Exam Site Name (i.e. Company Name) Street Address City State Zip 2016 Crane Institute of America Certification, LLC. All rights reserved. Page: 2 of 4 Form: CO-EOS

3 Examiner Observation Sheet Crane Inspection and Radius Questions (Circle your responses) Yes No 44. Candidate correctly answered inspection question Candidate pointed to column on the load chart representing the radius of the crane. 1 2 E. Challenge One Accuracy and Depth Perception Drum 1 Initial Score Final Score Hook or ball touched the ground outside of Drum Hook or ball touched any drum other than Drum Knocked over any drum other than Drum 1 (Do Not Stop) Knocked over Drum 1 (Stop task 1, write 5:30 in Total Time below, and place headache ball in Drum 1) Total time (give 2:30 min warning, 5:30 minutes max) 1 2 : 1 2 : Moved Drum 1 more than 2 inches (Determine after exercise) Drum 2 Initial Score Final Score Hook or ball touched the ground outside of Drum Hook or ball touched any drum other than Drum 1 or Knocked over any drum other than Drum 2 (Do Not Stop) Knocked over Drum 2 (Stop task 2, write 5:30 in Total Time below, and place headache ball in Drum 2) Total time (give 2:30 min warning, 5:30 minutes max) 1 2 : 1 2 : Moved Drum 2 more than 2 inches (Determine after exercise) Time Question (circle your response) Yes No 70. Did the Candidate take the full 5:30 minutes in BOTH tasks above? 1 2 F. Challenge Two Hand Signals Initial Score Final Score (Circle your responses) Signal Performed Stopped Performed Stopped Order Signal on Signal Signal on Signal Complete each signal once Yes No Yes No Yes No Yes No Raise load and stop Swing and stop Swing slowly and stop Raise boom and stop Lower boom slowly and stop Lower load slowly and stop G. Challenge Three Ability to Control a Load Initial Score Final Score Hit drum with any part of the test load Knocked over drum Chain left the ground (but not above drums) Chain raised above drums used on course (Give extra mark for each drum passed with chain above it) Load touched ground/any board other than starting point board Total time (give 4 min warning; 9 minutes max) 1 : 1 : Moved a drum more than 2 inches (Determine after exercise) H. Challenge Four Exiting the Crane Safely Initial Score Final Score (circle your responses. If Not Applicable circle number under NA) Yes No NA Yes No NA Secure the crane (set brake/locking devices) point dismount performed, facing crane Crane Institute of America Certification, LLC. All rights reserved. Page: 3 of 4 Form: CO-EOS

4 Examiner Observation Sheet I. Observation of Non-Allowable Activity Initial Score Final Score Adjusted outriggers Telescoped the boom Did not follow other directions (ex. Getting out of crane without being instructed to do so) Describe in Comments box below. J. Automatic Disqualification Stop Exam if any occur Initial Score Final Score (Circle your responses) Yes No Yes No Two blocking the crane Hit crane with any part of the load Uncontrolled or reckless operation Action dangerous to personnel or equipment Traveling the crane K. If no disqualification, check the box next to the answer that in your opinion best describes the performance of the person on this exam This response is required for validation, BUT IS NOT USED FOR SCORING (circle your response): 1 Definitely Passed 2 Barely Passed 3 Barely Failed 4 Definitely Failed 136. Comments: Use the space below to describe the reason for Automatic Disqualification in Section J (and get signatures), or write any comments about the exam (no signature required): 137. Examiner s Signature (if disqualified) FOR OFFICE USE ONLY: 138. Date (mm/dd/yyyy) 139. Proctor s Signature (if disqualified) FOR OFFICE USE ONLY: 140. Date (mm/dd/yyyy) 141. Candidate s Signature (if disqualified) FOR OFFICE USE ONLY: 142. Date (mm/dd/yyyy) 143. Has the Examiner and Proctor checked each other s observation sheets for accuracy and completeness? Observation Sheets must be complete to prevent delays in scoring and issuance. FOR OFFICE USE ONLY Test Code: Form ID: Candidate ID matches: Y N 2016 Crane Institute of America Certification, LLC. All rights reserved. Page: 4 of 4 Form: CO-EOS

5 Crane Operator Practical Exam Proctor Observation Sheet Examiner s Name Proctor s Name (Legal) Proctor s Signature Crane Inspection and Radius Questions (Circle your responses) Yes No 44. Candidate correctly answered inspection question Candidate pointed to column on the load chart representing the radius of the crane. 1 2 E. Challenge One Accuracy and Depth Perception Drum 1 Initial Score Hook or ball touched the ground outside of Drum Hook or ball touched any drum other than Drum Knocked over any drum other than Drum 1 (Do Not Stop) Knocked over Drum 1 (Stop task 1, write 5:30 in Total Time below, and place headache ball in Drum 1) Total time (give 2:30 min warning, 5:30 minutes max) 1 2 : Moved Drum 1 more than 2 inches (Determine after exercise) Drum 2 Initial Score Hook or ball touched the ground outside of Drum Hook or ball touched any drum other than Drum 1 or Knocked over any drum other than Drum 2 (Do Not Stop) Knocked over Drum 2 (Stop task 2, write 5:30 in Total Time below, and place headache ball in Drum 2) Total time (give 2:30 min warning, 5:30 minutes max) 1 2 : Moved Drum 2 more than 2 inches (Determine after exercise) Time Question (circle your response) Yes No 70. Did the Candidate take the full 5:30 minutes in BOTH tasks above? 1 2 F. Challenge Two Hand Signals Initial Score (Circle your responses) Signal Performed Stopped Order Signal on Signal Complete each signal once Yes No Yes No Raise load and stop Swing and stop Swing slowly and stop Raise boom and stop Lower boom slowly and stop Lower load slowly and stop G. Challenge Three Ability to Control a Load Initial Score Hit drum with any part of the test load Knocked over drum Chain left the ground (but not above drums) Chain raised above drums used on course (Give extra mark for each drum passed with chain above it) Load touched ground/any board other than starting point board Total time (give 4 min warning; 9 minutes max) 1 : Moved a drum more than 2 inches (Determine after exercise) H. Challenge Four Exiting the Crane Safely Initial Score (circle your responses. If Not Applicable circle number under NA) Yes No NA Secure the crane (set brake/locking devices) point dismount performed, facing crane Crane Institute of America Certification, LLC. All rights reserved. Page: 1 of 2 Form: CO-POS

6 Proctor Observation Sheet I. Observation of Non-Allowable Activity Initial Score Adjusted outriggers Telescoped the boom Did not follow other directions (ex. Getting out of crane without being instructed to do so) Describe in Comments box below. J. Automatic Disqualification Stop Exam if any occur Initial Score (Circle your responses) Yes No Two blocking the crane Hit crane with any part of the load Uncontrolled or reckless operation Action dangerous to personnel or equipment Traveling the crane 1 2 Comments: Use the space below to describe the reason for Automatic Disqualification in Section J (and get signatures), or write any comments about the exam (no signature required): Examiner s Signature (if disqualified) FOR OFFICE USE ONLY: Date (mm/dd/yyyy) Proctor s Signature (if disqualified) FOR OFFICE USE ONLY: Date (mm/dd/yyyy) Candidate s Signature (if disqualified) FOR OFFICE USE ONLY: Date (mm/dd/yyyy) Has the Examiner and Proctor checked each other s observation sheets for accuracy and completeness? Observation Sheets must be complete to prevent delays in scoring and issuance. FOR OFFICE USE ONLY Test Code: Form ID: Candidate ID matches: Y N 2016 Crane Institute of America Certification, LLC. All rights reserved. Page: 2 of 2 Form: CO-POS