| Trainee
Name____________________________ |
| Trainee
Social Security Number: ____________ |
| Trainee
Status: _______ |
| Course
Name: ___________________ |
| Course
Code: ___________________ |
| National
Center Course Number: ___________ |
| Date Course
Completed: ____________________ |
| Performance
Criteria Completed: _____________ |
| Performance Objectives: | ||
| Pass | Fail | |
| Topic 1: Block and Tackle | ||
| 1.1 Properly use a simple block and tackle to lift a load. | ____ | ____ |
| 1.2
Select the proper compound block and tackle for a specific job, inspect the parts of the block and tackle, properly reeve the blocks, and properly use the block and tackle to lift a load. |
____ | ____ |
| 1.3
Use a formula to select the appropriate block and tackle to lift a given weight. |
____ | ____ |
| Topic 2: Hoists, Jacks, and Winches | ||
| 2.1 Properly use a chain hoist to lift a load. | ____ | ____ |
| 2.2 Properly use a come-along to move a load. | ____ | ____ |
| 2.3 Properly use a jack to raise a load. | ____ | ____ |
| 2.4 Properly use a winch to lift a load. | ____ | ____ |
| Topic 3: Slings and Levelers | ||
| 3.1
Explain how sling angles and hitch patterns affect a sling’s lifting capacity. |
____ | ____ |
| 3.2
Properly use a turnbuckle to adjust the length of a sling leg. |
____ | ____ |
| 3.3 Properly use a load leveler to balance a load. | ____ | ____ |
| Performance
Evaluator’s Signature:____________________________ |
| Performance
Evaluator’s Name (Print):____________________________ |
| Date
Completed:____________________________ |