Title Page

  • Date

  • Prepared By

  • Team Member(s)

  • Records

  • Quality Control

  • Customer Name

  • Complaint Area(s) Of Concern

  • Bathroom Complaint Concerns

  • Dirt Found

  • Detail Area

  • Kitchen Complaint Concerns

  • Dirt Found

  • Detail Area

  • Dusting Complaint Concerns

  • Dirt Found

  • Detail Area

  • Vac Complaint Concerns

  • Dirt Found

  • Detail Area

  • Complaint Customer Name

  • Compliment Customer Name

  • Area

  • Complaint Customer Name

  • Complaint Customer Name

  • What Vacuum?

  • Issue Details

  • Team Work

  • Multiple People?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Images

  • Notes

  • Multiple People?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Images

  • Notes

  • Team Member

  • Issue

  • Multiple People?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • What Team Was Helped

  • Multiple People?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Form Type

  • Reason For Warning

  • Type of Warning

  • Failed Driving Score

  • Area Of Concern

  • Date of incident

  • Location of incident

  • Multiple People?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

Subsection

  • Subsection

  • Date of incident:

  • Quality Control

  • Customer Name

  • Complaint Area(s) Of Concern

  • Bathroom Complaint Concerns

  • Dirt Found

  • test

  • Detail Area

  • Kitchen Complaint Concerns

  • Dirt Found

  • Dusting Complaint Concerns

  • Dirt Found

  • Vac Complaint Concerns

  • Dirt Found

  • Team Member

  • Team Member

  • Team Member

  • Form Type

  • Current Hourly Rate

  • New Hourly Rate

  • Length of Time Worked

  • ATTENDANCE: The employee’s absenteeism and tardiness during regular working hours.

  • Quality: The ability of the employee to produce work that meets or exceeds Company standards. ( Compliments- 5 Star Reviews- Complaints- Inspections- Breakages- )

  • PRODUCTIVITY: The employee’s actual output of work in relation to that required by the job. (# of Homes Cleaned First Cleans- Second Cleans- One Time Cleans - COGS- Helping Hands- )

  • JOB KNOWLEDGE (Product, Service) The employee’s knowledge of concepts as they relate to the job and the interest shown in this area.

  • VERSATILITY: The employee’s ability to do a variety of duties within the department.

  • FOLLOWING INSTRUCTIONS: The employee’s ability to read, understand and comply with instruction. Also, how well the employee follows instructions from the supervisor/manager.

  • INITIATIVE: The employee’s ability to apply him/herself while on the job, plans work efficiently, & willingness to assume personal responsibility.

  • COMPATIBILITY / Team Work: The employee’s relationship and degree of cooperation in contact with others required in his/her work.

  • How are things going with your teammate?

  • NEATNESS: The degree to which the employee maintains a clean work area and cares for his/her equipment.

  • ATTITUDE: The employee’s cooperation with team & management. Willingness to work overtime when necessary.

  • Employees Comments

  • Challenge For Future

  • Team Leader Signature______________________________________________________

  • Team Member Signature_____________________________________________________

SECTION 1: SELF EVALUATION (To be completed by Employee) Personal evaluation and feedback are a very important part of the employee review process. Please complete the following questions with well thought out answers.

  • 1. Define your overall job responsibilities. List any specific goals, objectives, tasks or assignments you had during this period. (Add additional entries if needed). Briefly state how you accomplished these objectives/goals or why objectives/goals were not met.

  • Objective/Goal #1:

  • Objective/Goal #2:

  • Objective/Goal #3:

  • Objective/Goal #4:

  • 2. List any accomplishments, awards, activities, certifications and training that you received during this past review period that you feel have added to your performance or helped you advance your career path.

  • 3. How would you describe your overall performance during this past review period?

  • 4. What steps could you take to improve your performance? Is there anything that your supervisor could do to help you accomplish that? What training and/or job assignment would help you progress in your career path?

LEADERSHIP ESSENTIALS - EMPLOYEE SECTION

  • Refer to Engineers Competency template in Guidance Documents DO = Development Opportunity D = Demonstrates S = Strength
    Click on each box to select from the drop down options

  • THOUGHT LEADERSHIP

  • Strategic Thinking

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Enterprise Mindset

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Entrepreneurial Risk Taking

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • RESULTS LEADERSHIP

  • Customer Focus

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Change Leadership

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Execution

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • PEOPLE LEADERSHIP

  • Inspire and Influence

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Collaborate Across Boundaries

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Develop Talent

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • SELF LEADERSHIP

  • Courage

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Agility

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • Self-Direction

  • Area of Focus:

  • Comments (optional)

  • Reference Positive Actions:

  • BEHAVIOURS SUMMARY

  • Results achieved against goals were below expectations. The employee did not demonstrate the Tyco Values and/or Leadership Essentials required for successful performance.

  • Results achieved against goals have not consistently met expectations or employee may have achieved goals but may have not demonstrated the Tyco Values and/or Leadership Essentials required for successful performance.

  • Results achieved against goals met expectations. Demonstrated or improved demonstration of Tyco Values as well as Leadership Essentials necessary for successful performance.

  • Results achieved against goals met and often exceeded goal expectations. Demonstration of Tyco Values and Leadership Essentials necessary for successful performance at or above standard.

  • Results significantly exceeded goal expectations. Exemplary demonstration of the Tyco Values and Leadership Essentials necessary for successful performance. This rating distinguishes a employee who was easily recognised as extraordinary for the fiscal year.

  • RESULTS SUMMARY

  • Results achieved against goals were below expectations. The employee did not demonstrate the Tyco Values and/or Leadership Essentials required for successful performance.

  • Results achieved against goals have not consistently met expectations or employee may have achieved goals but may have not demonstrated the Tyco Values and/or Leadership Essentials required for successful performance.

  • Results achieved against goals met expectations. Demonstrated or improved demonstration of Tyco Values as well as Leadership Essentials necessary for successful performance.

  • Results achieved against goals met and often exceeded goal expectations. Demonstration of Tyco Values and Leadership Essentials necessary for successful performance at or above standard.

  • Results significantly exceeded goal expectations. Exemplary demonstration of the Tyco Values and Leadership Essentials necessary for successful performance. This rating distinguishes a employee who was easily recognised as extraordinary for the fiscal year.

  • Employees Comments

  • Challenge For Future

  • Team Member

  • Leadership

SELF EVALUATION (To be completed by Employee) Personal evaluation and feedback are a very important part of the employee review process. Please complete the following questions with well thought out answers.

  • 1. What do you like the most about your current position?

  • 2. What aspects of your job would you most like to change or eliminate and why?

  • 3. How would you describe your overall performance during this past review period?

  • 4. What steps could you take to improve your performance? Is there anything that your supervisor could do to help you accomplish that? What training and/or job assignment would help you progress in your career path?

  • 5. What are one or two examples of ways in which you've grown professionally within the last evaluation period?

  • 6. What specific skills would you like to develop within the coming evaluation period?

  • 7. What career growth or Life goals do you hope to accomplish in the next three years?

  • 8. Do you feel that you embody company values? If so, which ones?

  • Reason For Warning

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 3.3 ATTENDANCE POLICY

    Missing work puts a burden not only on the office for scheduling but also on your partner and the rest of the cleaners who must pick up your houses. ABSENTEEISM WILL NOT BE TOLERATED! Attendance is an essential job function. Employees missing too much work may be terminated.

    All unpaid time off must be arranged with management in advance. You are required to give the office Five (5) working days’ notice if you want to take a full day off, and Three (3) days' notice if you want to take a partial day off. This means that if you must arrive late or leave early or will be unable to work past 5:00 p.m. to complete scheduled jobs, you must give the office three (3) working days' notice. Scheduled absences may be taken in 1-hour increments, not to exceed a total of 56 scheduled hours (8 days, 7hrs a day) per anniversary date year. Scheduled absences can be used any day of the work week. The management reserves the right to approve or deny the request for scheduled time off at their discretion.


    Medical Leave with written doctor approval will be evaluated on a case-by-case basis.


    No show & no call before the next working day is at the Manager's discretion, employee is subject to being sent home without work/pay, termination or suspension.

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 3.2 LATENESS POLICY

    You are required to arrive at the office no later than 8:00 a.m. If you will arrive after 8:00 a.m. but before 8:04 a.m., you are not considered late. You must call the office prior to 8:00 a.m., if you will be later than 8:04am. By calling before 8:00am you will receive 2 grace tardies a year if you do not call the office before 8:00 a.m., you will be considered late. Employees who arrive late may be subject to the penalties set forth in section 3.4.

    The two grace tardies will be awarded after the probation timeframe has been completed (90 days).

    If you leave any time before your team’s houses have been completed, or when your team’s houses are finished but you are needed to assist another team in finishing their houses, it will be considered an early departure. Early departures are subject to the same penalties as late arrivals.

    On days where there are enough employees to complete all the houses and the Company is fully staffed, only those employees arriving before 8:00 a.m. (unless a phone call has been received) will be placed on a team. At the Manager's discretion, employees arriving after 8:04 a.m. are subject to being sent home without work/pay.

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 5.1 QUALITY CONTROL

    The objective of the Company is to reward employees who are dependable, do-good quality work and take pride in the work they do. Quality work is the cornerstone of our Company. Without quality work we have no customers today or jobs tomorrow. You will meet with Management and other team members regularly to review your performance.

    If the quality of your performance falls below an acceptable level, management may require one or more of the following items:

    1. Reviewing of paper work
    2. Testing knowledge of above procedures or any other problem areas
    3. Shadowing with another team until quality improves
    4. Moving to floater status
    5. Terminating employment

    **During this period of retraining, you may be paid at the federally permitted minimum wage rate.

    Listed below are typical quality problems. These problems have a detrimental effect on either the customer, the office or your fellow workers. If you have too many of the following problems, you will either be sent back for retraining or terminated.

    ·Complaint on the 1st/2nd Initial Deep Clean
    ·Complaint on detailed areas of focus
    ·Complaint regarding behavior or language
    ·Poor Inspection
    ·Failure to read Customer Notes
    ·Failure to maintain supplies/equipment
    ·Failure to clock in/out of house

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 2.1 GENERAL POLICY

    As an employee of the Company, you are always expected to present yourself in a professional manner and work as thoroughly, efficiently and productively as possible. You must have high professional ethics and be firmly and totally supportive of the Mission of the company. Our quality of work must be superior at all times.

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 2.4 DRESS CODE

    Clothing should be conservative and in good taste at all times. You are required to wear a logo shirt while on the job at all times. Additional logo shirts can be purchased for $20.00. You will not be permitted to work without a logo shirt. Shoes must be worn at all times and must be closed toe, soft sole, and non-skid (similar to tennis shoes). Sandals, flip-flops & similar shoes are not allowed. No facial piercing will be allowed accept small nose pierces that are flush to the side of the skin.

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 2.1 GENERAL POLICY

    As an employee of the Company, you are always expected to present yourself in a professional manner and work as thoroughly, efficiently and productively as possible. You must have high professional ethics and be firmly and totally supportive of the Mission of the company. Our quality of work must be superior at all times.

    All employees are under a 90-day probation time frame. This is for us both to evaluate the dedication, Quality, Professionalism & how the employee relates with our customers.

  • Type of Warning

  • You are being written up today due to your actions being in violation of the Employment Agreement. The recorded date(s) of these occurrence(s) are as follows:

  • 2.5 EMPLOYEE RESPONSIBLITIES

    You are responsible for servicing the houses assigned each day and for doing you’re utmost to complete all the houses assigned each day. You will be asked to work until ALL SCHEDULED houses in the Company for any given day are completed (regardless of which team normally services the house). When problems arise during the day it is your job to notify the Company office immediately. When in doubt, call the office. When you finish your tasks at a house, you are expected to help the other team members until the homes have all been completed.

    You are also responsible for coming to work regularly and on time and share the driving with your teammate. If you need time off or must be late, please refer to the attendance and leave policies in the next section.

    We all MUST follow the laws with cell phones as NO texting while driving; we also should respect our fellow team mates and not have our cell phones on our presents. Please have them in a book, Truck or your desk draw. Cell phones create a distraction and can be very disrespectful to the people around you.

  • Continuation of these actions may result in one of or multiple of the following actions:
    1. Write up
    2. Suspension
    3. Termination

  • Team Leader Signature______________________________________________________

  • Team Member Signature_____________________________________________________

  • ISSUE DETAILS:

  • Do you agree with details listed above. Sign Below.
    YES: _________________________________________
    NO: __________________________________________

  • Team Leader Signature______________________________________________________

  • Team Member Signature_____________________________________________________

  • Issue

  • Attendance Issue

  • Location of accident

  • Date of accident

  • Describe fully how the accident occurred (including events that occurred immediately before the accident)

  • Describe bodily injury sustained (be specific about body parts(s) affected)

  • Recommendation on how to precent this accident from recurring

  • Were there any witnesses?

  • Team members

  • When was this reported to the supervisor?

  • Who was the injury reported to?

  • Did they need medical attention?

  • Name of treating physician

  • Contact number of treating physician

  • Date of care

  • Treatment administered

  • Drug test results (select all that were negative)

  • Were they cleared to work by their physician?

  • When?

  • Do they need any accommodations at this time?

  • Please describe

  • If known, when will they be cleared?

  • Date of incident

  • Location of incident

  • Please describe the incident in detail

  • Were there any witnesses?

  • Multiple people?

  • How many people?

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Employee Name

  • Suggestions for resolving the complaint

  • Is this the first complaint about this person?

  • Corrective action taken

  • undefined

  • Team Member Signature _________________________________________

  • Team Leader 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.