Evers and Sons SSE Evaluation

• Department

  Select Facilities Pipeline Fabrication Shop Other

  • Facilities
  • Pipeline
  • Fabrication Shop
  • Other

• Employee Name:

• Employee Position:

• Conducted on

  Date

• Evaluation Conducted By:

EMPLOYEE REVIEW

• Has employee completed the new hire orientation and all required training mandated by the position held?

  Yes

  No

• Employee must complete all training prior to graduation.

• Is the employee familiar with the company Stop Work Authority policy and process?

  Yes

  No

• Employee must be re-educated on the process before completion of the review.

• Is the employee familiar with the Behavior Based Safety Process?

  Yes

  No

• Can they demonstrate the correct completion of an observation or have cards previously completed by the employee been determined to be complete and correct?

  Yes

  No

• Employee must be re-educated on the process before completion of the review.

• Employee must be re-educated on the process before completion of the review.

• Is the employee familiar with the JSA Process?

  Yes

  No

• Can they demonstrate the correct completion of a JSA or has a previous JSA completed by the employee been determined to be complete and correct?

  Yes

  No

• Employee must be re-educated on the process before completion of the review.

• Employee must be re-educated on the process before completion of the review.

• Was the employee involved in any accidents during the SSE period?

  Yes

  No

• Was the employee determined to be in violation of company or customer policies or procedures resulting in the accident?

  Yes

  No

• STOP REVIEW: Employee must remain in SSE status for 90 days before review may be completed. Have employee sign the review and explain that he or she must remain accident and violation free during the 90 day period to be re-considered for SSE graduation.

• Regardless of the results of the above questions, is there any reason that the evaluator feels that he employee should remain in the SSE program?

  Yes

  No

HSE REVIEW

• Has employee received any warning citations resulting from HSE policy violations?

  Yes

  No

• Has the employee demonstrated his/her ability to adjust properly to corrective action?

  Yes

  No

• Stop review and consult with employees supervisor.

• Consult with the employee's supervisor. Did the employees supervisor provide any reason why he felt that the employee should remain in the SSE program?

  Yes

  No

CLOSING

• Is employee cleared for SSE graduation?

  Yes

  No

• Final comments:

• Evaluator signature:

  Sign

• Employee signature:

  Sign