Information

Personnel Section

  • Employee Name

  • Employee Status

  • Prepared By

  • Observation Date / Start Time:

  • Reason for CMO

  • Details

Skill in Methods

Method Grades

  • 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

  • Collects the order from office or from correct place

  • Checks that order is for correct run and has correct dest stickers

  • Collects safe empty plt & loads on to pick truck correctly

  • Picks order checking off each line as picked to avoid errors

  • Stacks cartons in a safe way to ensure no damage to product

  • No lost time when picking - Finds pick bins with out issues, MHE close by, Not restacking plt

  • Completes order and stages in correct location - Wrapping if needed

  • Completes all paperwork for order and moves on to next task

  • Stop Time:

Safety Elements

  • Unsafe = Unsafe behaviour observed
    Safe = Safe behaviour observed
    NA = Not observed / Not required

  • Safe use of MHE - Seatbelt, Use of horn, Slow in blind spots

  • Correct lifting technique used

  • Safe stacking of cartons to avoid plt falling over

  • Safe around reach truck in room - 2 Bay rule

Safety Engagement

Safety Engagement

  • Safety Engagement Details

  • Details / Comments

Perfomance

Performance

  • 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

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

  • Effort Level

  • 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

  • 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 moment details

Employee ideas or suggestions

  • Has the employee got any ideas or suggestions for improvements to the site or the business

  • Please provide comments

  • Associate Signature:

  • Supervisor 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.