/ EQUIPMENT USER EVALUATION FEEDBACK FORM / FBMR 13.0.2
Queensland State Emergency Service
Name of Equipment:
Period of Time Equipment was Trialed:
Type of Activities undertaken with Equipment: Training Operations Other :

Please provide brief details of activities undertaken:

1. Ergonomically, did you find the ease and comfort of operator use acceptable? Yes No

If No, please provide details of the issues identified.

2. Does the equipment perform its role effectively? Yes No

If No, please provide details of the issues identified.

3. Are accessories/connections easy to attach/load and utilise? Yes No N/A

If No, please provide details of the issues identified.

4. Are the built in safety features of the equipment appropriate? Yes No N/A

If No, please provide details of the issues identified.


5. Are there any workplace health and safety concerns or applications of the equipment where the current SES issued personal protective equipment (PPE) does not adequately protect the user? Yes No N/A

If Yes, please provide details on the issues identified and any advice on PPE that may be required to address these safety issues.

6. Are there any storage issues? Yes No N/A

If Yes, please provide details of the issues identified and any advice on how these may be overcome.

7. Are there any cleaning issues? Yes No N/A

If Yes, please provide details of the issues identified and any advice on how these may be overcome.

8. If an operator manual is provided, is it acceptable? Yes No N/A

If No, please provide details on the issues identified.

9. Was the introductory training provided in the use of this equipment adequate? Yes No N/A

If No, please provide details on the issues identified and any advice on how this training could be improved.

10. Have you identified any limitations of the equipment? Yes No N/A

If Yes, please describe the limitations of the equipment and any advice on how these could be overcome or improved.


11. Did local climate, conditions or environment have an impact on the suitability of the equipment or the comfort of the user? Yes No

If Yes, please describe the positive or negative impact of these factors.

12. Does the equipment enhance SES operations? Yes No

13. Would you like to see this equipment approved for introduction into SES operations? Yes No

Please provide any other comments relating to the trial of this equipment:
Name / SES Unit
Membership No. / Qualifications
Signature / Date / //

Please provide completed forms to your Local Controller. The Local Controller will collect all forms and forward to the EMQ Regional Director.

/ Page 1 of 3 / Date: 19/01/2010 / BMR 13.0.2
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