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. Confirm assignment on the VMU without undue delay

  • 2. Travel to staging location in most direct route

  • 3. Scans the pallet and reviews storage location

  • 4. If traveling with two pallets, press F5 to scan additional pallet

  • 5. Verifies pallet is in good condition for storage

  • 6. Operator travels to storage location in most direct route with forks at proper travel height

  • 7. Confirms location is correct

  • 8. Raises forks to needed height without undue hesitation

  • 9. Places pallet correctly in location. Pallet is placed straight in location and at proper depth in bay

  • 10. Lowers forks to travel height without undue delay

  • 11. Scans location to complete putaway task

  • 12. Proceeds to next assignment as directed in an efficient manner

  • Stop Time:

  • Delay Minutes (observed)

Safety Elements

  • Scoring Safety Elements
    Safe (S) = Safe Behaviors
    Unsafe (US) = Unsafe Behaviors
    NA = Not Applicable

  • 1. Maintained all body parts (feet, legs, hands, and arms) inside operator compartment, when in use.

  • 2. Ensured MHE was at complete stop, before dismounting.

  • 3. Maintained lift at proper distance from pallet, during picks / pallet wrapping, to avoid trip hazard.

  • 4. Demonstrated proper lifting techniques.

  • 5. Demonstrated proper driving techniques and sounded horn when entering doors, between cross aisles, around blind spots and exiting trailers.

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.