Title Page
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Trainee
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Job Number
Safety Orientation Review
Safety Orientation Review
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Review required PPE
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Review location of the Emergency Eye Wash and Shower stations
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Review the Emergency Evacuation and Take Cover locations
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Review the location of all Emergency Stops
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Review any hazards of the equipment being used
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Review any possible general hazards (e.g. lifting hazards, water/steam hazards, contamination hazards)
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Review proper housekeeping expectations (e.g. hang water hoses, pick up caps/bottles on floor)
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Review lockout points of equipment
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Supervisor Signature
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Date
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Trainee Signature
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Date
Weekly OJT Evaluation Form
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Trainee Name
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Clock #
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Evaluator
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Job #
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Evaluated Date
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Training Week #
Follow Safe Practices
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1. Wear correct PPE for the job at all times
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Follow all safe practices required for the job
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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3. Identify and use lockout points required for the job
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
Sanitation
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1. Demonstrate good housekeeping at all times
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Demonstrate clean-up procedure during normal production and weekend clean-up
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
Quality Checks/Finished Goods Inspections
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1. Perform quality checks in compliance with Quality Assurance Standards
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Enter data into infinity QS and/or record results of Quality inspections
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
Documentation
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1. Properly document information including HOTS downtime and inspections
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Update oscar boards throughout shift as required
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
Equipment/Line Operation
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1. Start-up, operate and shutdown equipment
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Operate machinery in accordance with all JSAs including troubleshooting procedures
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
Interpersonal Skills
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1. Communicate with Trainer to learn job
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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2. Work as a team member with Co-workers
- N/A
- Never
- Seldom
- 50% of the time
- Almost Always
- Always
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Comments
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OJT Trainer Signature
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Date
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Supervisor Signature
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Date
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Continue Training?
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Training Complete
Lockout Assessment
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Employee Name
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Department
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Prepared by
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Equipment
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Date
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Locks Needed
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Locks Issued
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Type of Energy Locked Out
- Electrical
- Air
- Product Valve
- Steam
- Water
- Chemical
Assessment
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Does the authorized employee know the location of the written lockout procedure?
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Does the authorized employee have access to the energy isolating devices such as the disconnects and valves to fully de-energize equipment?
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Were affected employees notified by the authorized employee prior to the lockout procedure being used?
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Did the authorized employee perform a machine stop prior to locking out equipment?
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Did the authorized employee follow the correct lockout procedure for the equipment being locked out?
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Did the authorized employee verify all energy is dissipated and is properly de-energized?
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Do the current energy isolating devices reflect the posted procedure? Are any changes to the procedure needed?
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Were alternative procedures reviewed with the authorized employee
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Deficiency #1
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Deficiency #2
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Deficiency #3
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Employee Signature:
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Supervisor Signature:
ORM Department (Do Not Fill Out)
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Deficiencies have been corrected?
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Safety Coordinator Signature:
Good Documentation Practices
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Trainee Name
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Clock#
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Evaluator/Trainer
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Training Start Date
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Training End Date
Performance Observation
JSA Sign-Off
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Job#
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Human Resources Permanent Bid - Ability Form
