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: _____________________________________________