DRC-2025-002241

CLIVE SITE
LETTER OF TRANSMITTAL DATE: 7/7/2025 ATTN: LLRW
CC; Treesa Parker Karen Kirkwood RE: Transmittal 2025-042
Description of Documents Transmitted Qty
See attached updates for Qualification Cards. Q1142F Rev 3, Fork Equipped Loader Operator 1
------------------------------------------------------------------------------------------------------------ Please replace your current procedure revisions with the documents within this Transmittal. You are not required to sign any documents to verify receipt of this distribution. However, you should make every effort to ensure that your copy of the License is current. FROM: EnergySolutions
Document Control Clive Facility
CL-TN-PR-100-F7
Revision 1
QUALIFICATION CARD
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EMPLOYEE NAME ___________________________________________
QUALIFICATION #: QUALIFICATION TITLE:
QUALIFICATION APPROVAL:
SCOPE:
THIS DOCUMENT APPLIES TO PERSONNEL WHO ARE OR MAY BE REQUIRED TO OPERATE A FORK EQUIPPED
LOADER THAT IS OWNED OR OPERATED BY ENERGYSOLUTIONS.
THIS QUALIFICATION EXPIRES EVERY 2 YEARS.
PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS
Q1142 LOADER OPERATOR
(ADD ADDITIONAL LINES AS NECESSARY)
PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS
APPLICABLE EQUIPMENT OPERATORS MANUAL
JHA CL-GF-4536 EQUIPMENT OPERATIONS
(ADD ADDITIONAL LINES AS NECESSARY)
QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS
CLASSROOM TRAINING WITH WRITTEN EXAM
PASSED AT 80% OR HIGHER
COMPLETION OF PRACTICAL EVALUATION &
PRE-USE INSPECTION FORM
(ADD ADDITIONAL LINES AS NECESSARY)
PRACTICAL CRITERIA:
Q1142F FORK EQUIPPED LOADER OPERATOR
Task
(Description)
Satisfactory
(Check Mark)SME Date
(Completed)Initials
Performs the Pre-Use Inspection correctly.
Demonstrates ability to steer and turn smoothly.
Demonstrates ability pickup, move, and place a
pallet.
Qual Manager ___________________________ ___________________________ Date_________
PRINTED NAME SIGNATURE
Radiation ___________________________ ___________________________ Date_________
Safety Officer PRINTED NAME SIGNATURE
Yes
Practical Evaluation (included) Yes/No
This SECTION is filled out by DOCUMENT CONTROL.
Effective Date: ______________
________________
Revision No.: _3_ 7/7/2025
Roger Ekins Digitally signed by Roger Ekins
Date: 2025.07.07 11:05:35 -06'00'
Thomas Brown Digitally signed by Thomas Brown
Date: 2025.07.07 11:38:38 -06'00'
CL-TN-PR-100-F7
Revision 1 QUALIFICATION CARD

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Demonstrates ability to brake and stop
appropriately.
Sounds horn at all appropriate locations.

Keeps forks at appropriate height while
traveling.
Demonstrates ability to maintain a safe travel
speed.
Demonstrates ability to allow clearance when
turning.
Accelerates/Decelerates at gradual rate.

Demonstrates ability to stop with a load.

Demonstrates ability to maneuver turns with a
load.
Inspects and Wears all safety equipment (i.e.
seat belt, harness, etc.) while operating lift.
Demonstrates ability to load and unload a truck
trailer safely.
Demonstrates knowledge and safe usage of fork
extensions/attachments.
Demonstrates the ability to proper park and
dismount the equipment.
ALL REQUIRED ITEMS HAVE BEEN COMPLETED AND THIS QUALIFICATION IS VALID:

EMPLOYEE _______________________ ______________________ DATE_________
PRINTED NAME SIGNATURE
EMPLOYEE MANAGER _______________________ ______________________ DATE_________
PRINTED NAME SIGNATURE
RSO _______________________ ______________________ DATE_________
PRINTED NAME SIGNATURE

Verification of Completed Documentation

QUAL MANAGER _______________________ ______________________ DATE_________
PRINTED NAME SIGNATURE

***ONCE COMPLETE, SCAN AND PLACE IN FOLDER FOR DATA ENTRY AND DOC CONTROL***

CL-TN-PR-100-F7
Revision 1 QUALIFICATION CARD

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