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
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Has the associate completed a working at heights permit prior to beginning with safety cage<br>
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Has the associate secured the safety cage correctly, using both pins and chains
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Please provide photo evidence
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Did associate check that door spring and latch were working correctly
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Is associate ensuring that cage passenger is wearing a harness<br>
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Has the harness been checked to ensure testing is within date
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Please provide photo evidence
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Does associate return all equipment back to correct area once task has been completed
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Stop Time:
Safety Elements
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Unsafe = Unsafe behaviour observed
Safe = Safe behaviour observed
NA = Not observed / Not required -
Forklift driver has current licence
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Pre op check done for forklift
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:
