Information
Personnel Section
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Employee Name
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Employee Status
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Prepared By
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Observation Date / Start Time:
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Reason for CMO
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Details
Skill in Methods
Method Grades
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Below = unsure, fumbles, hesitations (loses time)
Meet = steady, proficient, average (neither gains or loses time)
Exceed = safe, confident, quick, smooth (gains time)
Not observed = activity not observed
Method Steps & Safety Elements
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Does associate park MHE IN suitable area to complete cylinder change
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Has associate retrieved gloves and glasses before beginning
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Did associate check condition of "O" ring on new cylinder
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Has new cylinder been situated correctly on MHE? Is Pressure Relief Valve at 12 o'clock?
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Did associate check cylinder was turned off prior to attaching LPG hose
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Once attached did associate turn on/off valve back half a turn
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Has associate checked that there are no leaks using squeeze bottle with soapy water
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Did associate check that new cylinder is properly secured to MHE
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When completed did associate ensure that LPG cage was locked
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Has associate returned empty cylinder to cage and stored correctly
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Stop Time:
Safety Engagement
Safety Engagement
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Safety Engagement Details
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Details / Comments
Perfomance
Performance
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Skill in methods
Below = unsure, fumbles, hesitations (loses time)
Meet = steady, proficient, average (neither gains or loses time)
Exceed = safe, confident, quick, smooth (gains time) -
Skills in methods
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Effort Characteristics:
Below = slow, not best effort, slow motion
Meet = steady, enthusiastic, average
Exceed = fast, focused, sometimes too much -
Effort Level
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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 -
Time Utilization
Coachable Moment
Review Coachable Behavior with associate
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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
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Coachable moment details
Employee ideas or suggestions
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Has the employee got any ideas or suggestions for improvements to the site or the business
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Please provide comments
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Associate Signature:
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Supervisor Signature:
