Title Page
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Conducted on
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Prepared by
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Office Location
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FSM
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The Health & Safety Manager evaluates every FSM at least once each year. Prior to the FSM's evaluation, the Health& Safety Manager visits at least 20% of the technicians on the FSM's team to compare results with the FSM's evaluation of that technician. After the FSM evaluation, the Health & Safety Manager sets a meeting with the FSM to review the results and scores and sends a copy of the results of that meeting to the Regional Operations Manager and the Director of Field Operations.
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Was every technician who was employed at the start of the quarter on the FSM's team evaluated during the quarter?
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What was their team's speeding percentage compared to the last evaluation?
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What was their team's Harsh Brake compared to the last evaluation?
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What is their team's "Backing When Leaving" compared to the last evaluation?
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What was their team's auto loss rate compared to their last evaluation?
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What was their Injury Loss Rate compared to the last evaluation?
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Were the safety metrics stated in the PREPARATION section of the Technician's Safety Evaluations provided by the FSM accurate?
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Were the Health & Safety Manager's evaluation of an audited technician a similar experience? (if not then a joint evaluation of another selected technician will be scheduled for coaching purposes)
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Were all pictures that were required provided?
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Were all exceptions found by the FSM on evaluations followed up on and corrected in an appropriate time frame?
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Was the average time for this FSM to respond to an alert from their team?
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Are there references on the TPS reports that the new hire was supported by the FSM?
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Does the FSM's van and the Office have a backup of safety equipment to be used for immediate replacement (hardhat, safety glasses, first aid supplies, fire extinguishers, headlamps)?
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Did the FSM provide a complete and timely (within 24hrs) a Root Cause Analysis for every injury that happened to their team during the quarter?
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Was the suggested action on the Root Cause Analysis appropriate to eliminate/reduce similar incidents? Was it followed up on?
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FSM Signature
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Health & Safety Manager Signature