Authorisation form

I, ………………………………………………………………, being the …………………………………………...… for (company name) , hereby appoint

………………………………………………………. to operate (company name) Forklift Trucks. This authorisation is made in terms
of Section ……. of (Regulation). The appointee has undergone a pre-authorisation competency evaluation and
has satisfied all the requirements set out therein. This authorisation is effective from ………………………………… and
shall remain in force until cancellation.

Authority is hereby granted to the appointee to operate the following equipment:

No. Equipment Description
1
2
3
4

Duties and responsibilities of FLT operator include:

1. Performing routine inspection on the FLT and complete pre-use inspection checklist.
2. Moving goods from one location to another.
3. Following health and safety regulations and safe driving guidelines.
4. Ensuring proper stacking and storage of goods in the warehouse.
5. Reporting any damaged goods by forklift or lost goods.
6. Reporting all unsafe conditions and incident occur during the shift.
7. Parking the FLT in the designated area at the end of the shift.

You shall be required to adhere to FLT and Non-Integrated Working Platform Procedure.

Signature of authorising official

Signature…………………………………………………………………. Date……………………………………………

Acknowledgement and acceptance by FLT Operator.

I…………………………………………………………………, accept the authorisation as set out above. All the terms and conditions
governing this authorisation have been fully explained to me.
Signature…………………………………………………………………. Date……………………………………………