GUARDIAN ANGEL: 90 Day Evaluation

• Employee Name

• Take picture of employee (Headshot Only)

  Media

• Site

• Conducted on

  Date

• Auditors Name

Overall Job Performance To be completed by auditor(OHS Manager/Supervisor/Team Leader/ETC.)

• Rate the employee's job knowledge.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's quality of work.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's teamwork/ peer contact. (How well they work with others)

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's ability to work unsupervised.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's communication skills with management and others.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's adherence to company policy and procedure.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's attendance and lack of tardiness.

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's adherence to safety policy and procedure. (PPE, safe work practices, policies, procedures and H&S awareness)

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

• Rate the employee's respect for company property. (Company vehicle, company supplied tools, laptop, etc)

  Outstanding

  Above Standard

  Standard

  Below Standard

  Unacceptable

Employee Questionnaire (Questions to be asked by auditor to employee)

• Has the employee received and signed the appropriate JSAs? (utility, current position, etc.)

  Yes

  No

• 1. Has the employee had OTJ training on How a proper lockout is performed? (Have employee explain the lockout, tagout, tryout process.)

  Select Yes No Yes but employee could not explain process

  • Yes
  • No
  • Yes but employee could not explain process

• Notes:

• 2. Have the employee explain the Emergency Evacuation process. (meeting location, etc.)

  Good understanding

  Fair understanding

  Poor understanding

• Notes:

• 3. Have the employee explain the rules relating to Red, Yellow and Green Zones<br><br>(Intent-determine if the employee understands and can acknowledge the safety zones)

  Good understanding

  Fair understanding

  Poor understanding

• Notes:

• 4. Have the employee explain rules relating to lift truck operation.

  Good understanding

  Fair understanding

  Poor understanding

• Notes:

• 5. Have the employee explain what hot work is.

  Good understanding

  Fair understanding

  Poor understanding

• 6. Have the employee explain the rules relating to Confined/Restricted spaces.

  Good understanding

  Fair understanding

  Poor understanding

• Notes:

• 7. Give me an example of a time when you needed external assistance for a safety issue. How did you find someone to assist you? (Intent- To determine if candidate demonstrates an understanding of situations which may require outside assistance and the means of engaging suitably qualified people.)

  Select No Evidence of Safety Focus Some Evidence of Safety Focus Solid Evidence of Safety Focus Strong Evidence of Safety Focus Did Not Answer

  • No Evidence of Safety Focus
  • Some Evidence of Safety Focus
  • Solid Evidence of Safety Focus
  • Strong Evidence of Safety Focus
  • Did Not Answer

• Notes:

• Interviewer's Summary Comments:

• Recommended for New Hire Release?

  Yes

  No

• Why and what are the actions to be put in place to release the employee from new hire status?

• Employee's Signature

  Sign

• Auditors Signature

  Sign

• Auditor's title?