Information

Personnel Section

  • Associate Name:

  • ID Number:

  • Employee Status:

  • Prepared by

  • Observation Date / Start Time:

Reason for Observation

  • New Employee

  • New Job Assignment

  • Job Performance Review

  • Other (Describe)

  • Other reason for observation

Skill in Methods

Method Grades

  • Not Observed (NOB) = activity not observed
    Below (B) = somewhat clumsy, fumbles, hesitations (loses time)
    Meet (M) = steady, proficient, average (neither gains or loses time)
    Exceed (E) = safely reduces motion, quick, smooth (gains time)

Method Steps

  • 1. Receive assignment from Supervisor / Ops desk

  • 2. Prepare trailer for loading

  • 3. Open dock door and apply dock plate

  • 4. Enter pre-loading info as directed by VMU

  • 5. Verify product is in good condition and address damages

  • 6. Obtain and scan pallet for loading

  • 7. Travel directly to loading door and scan door as loading

  • 8. Place product on truck

  • 9. Return directly to staging location to obtain next pallet

  • 10. When loading complete, retract dock plate and close dock door

  • Stop Time:

  • Delay Minutes (observed)

Safety Elements

  • Safety remarks required

  • Scoring Safety Elements
    Below (B) = does not comply and/or understand
    Meet (M) = understands and performs most of the time
    Exceed (E) = understands and performs all the time

  • 1.

  • 2.

  • 3.

Performance Estimate

Performance Grades

  • Scoring Performance Estimate
    Below (B) = less than 0 Meet (M) = greater than 0 but less than +10 Exceed (E) = greater than +10

  • Skills in Methods

  • Method Characteristics:
    Below = somewhat clumsy, adds motion, fumbles, hesitation, errors
    Meet = follows methods, proficient, consistent, steady, average
    Exceed = precise and smooth, quick and sure, reduces motions, smart, perfection

  • Effort Level

  • Effort Characteristics:
    Below = slow, not best effort, slow motion
    Meet = steady, enthusiastic, average
    Exceed = fast, focused, sometimes too much

  • Time Utilization

  • Utilization Characteristics:
    Below = does not try to avoid delay, exceeds delay allowances, stops working to talk
    Meet = minimizes delay by following the methods, continues working while talking, sometimes successful at avoiding delay
    Exceed = eliminates delay by eliminating motion, always works - never talks, always successful at avoiding delay

Overall Performance Score

  • Performance Estimate =

  • Actual Performance from LMS

Coachable Moment

Review Coachable Behavior with associate

  • 5-Step Coaching Model
    1) Convey Positive Intent
    2) Describe behavior and actions observed
    3) State impact of desired coachable behavior(s)
    4) Ask associate to respond
    5) Focus discussion on solution

  • Was a Coachable Moment Observed:

  • Coachable category:

  • Coachable Behavior (Additional notes about employee's performance during this observation)

  • Follow-Up required:

  • Planned date for Follow-up:

  • Associate Signature:

  • Supervisor Signature:

  • Quality Audit by Managers

  • CMO Quality Feedback

  • Manager 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.