Information

  • Document Title

  • Department Supervisor

EMPLOYEE INFORMATION

  • Employee Name

  • Last four digits of social security number

COMPANY INFORMATION

  • Company

  • Department

  • Position

EVALUATION

  • Date of Evaluation

  • Evaluation conducted by:

RIGGING

  • Does the employee perform overhead rigging duties

  • Review rigger card to ensure it is current. If not current advise that rigger duties are suspended and contact supervisor immediately

  • Can demonstrate a proper rigging inspection

  • Can demonstrate proper rigging of a load

  • Able to identify rigging gear by name

  • Is familiar with tag line use and restrictions

WELDER HELPER DUTIES

  • Does the employee perform welder helper duties as part of his regular duties

  • Is familiar with PPE requirements associated with welder helper duties

  • Can demonstrate or describe hand tool inspection

  • Is employee aware of when a fire watch must be assigned

HOT WORK AND FIRE WATCH

  • Does employee perform hot work or fire watch duties as part of their regular duties

  • Can describe when a hot work permit is required

  • Can explain when a fire watch is required

  • Is aware of how long a fire watch must remain on site following the completion of hot work

  • Can explain what safety equipment is required when a hot work permit is required

  • Is aware of special fire extinguisher requirement

  • Is aware of Chevron specific fire blanket requirements

PERSONAL PROTECTIVE EQUIPMENT

  • Was wearing PPE required for the task being performed upon arrival

  • Can demonstrate proper inspection of PPE

  • Understand the limitations of PPE

  • Is familiar with BBI PPE policies

BEHAVIOR BASED SAFETY PROCESS

  • Is there evidence that the employee is participating in the process

  • Understands proper completion of the Take 5 card

  • Familiar with stop work authority policy

JSEA

  • Was a JSEA prepared for the task being performed upon arrival

  • Aware of when a JSEA must be updated

  • Can the employee demonstrate proper completion of a JSEA

ACCIDENT/NEAR MISS REPORTING

  • Is familiar with reporting criteria and procedures

  • Can define near miss

FUEL TRANSFER

  • Can describe and/or demonstrate fuel transfer procedures

  • Is aware that all spills must be reported immediately

SHORT SERVICE EMPLOYEES

  • Able to describe how SSE's are identified

SPUD UNIT OPERATION

  • Does the employee operate a spud unit as part of their duties

  • If possible, have a barge foreman or experienced boat captain familiar with proper spud operation available during review

  • Can the employee demonstrate proper inspection procedures

  • Is the employee able to demonstrate raising the spud in a controlled manner

  • Can employee demonstrate lowering the spuds in a controlled manner

  • Does the employee lock the spud brake after each operation

  • Ask the employee about traveling and what requirement must be met to travel (spud pins). Are they aware of the policy

CRANE OPERATION

  • Does the employee operate a crane as part of their duties

  • Ask to see crane operator card, is it current and appropriate for the crane operated

  • Can the operator demonstrate a proper crane inspection

  • Can the operator demonstrate knowledge of crane load chart

  • Does operator appear to have proper and reasonable control of the machine while operating

  • Give the operator some test hand signals, does he understand proper handsignals

BOAT SPECIFIC

  • Is the employee assigned to a boat

  • Position

  • Can describe emergency fire procedures

  • Can describe emergency man overboard procedures

  • Can describe emergency general alarm procedures

  • Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  • Is employee familiar with proper engine and generator maintenance

  • Is proficient with wheelhouse electronics including communication and navigation equipment

  • Can describe emergency fire procedures

  • Can describe emergency man overboard procedures

  • Can describe emergency general alarm procedures

  • Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  • Is employee familiar with proper engine and generator maintenance

  • Is proficient will wheelhouse electronics including communication and navigation equipment

  • Is familiar with the navigational "rules of the road"

  • Captain must be present during evaluation to ensure Deck Hand is providing honest answers

  • Can describe role in an emergency fire on lard situation

  • Can describe role in an emergency man overboard situation

  • Can describe role in an emergency general alarm situation

  • Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  • Is employee familiar with proper engine and generator maintenance

  • Is deck hand capable of throwing a rope

  • Is deck hand familiar with knots and rope handling

CONCLUSION

  • NOTES OR OBSERVATIONS:

  • Is additional training required?

  • Will the lack of training place the employee or personnel around him in danger?

  • CONTACT DEPARTMENT MANAGER IMMEDIATELY

  • ENSURE TRAINING IS SCHEDULED ASAP

ACKNOWLEDGEMENTS

  • Evaluator Name

  • Employee Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.