Employee Name and Payroll #:
What Department and Complex where task is being completed?
Employee's Current Occupation and how long he/she has been at the present job:
Type of Observation:
- Critical Task
- New Worker
- Incident Repeater
- Good Performer
- Poor Performer
Major steps required to complete task (eg. PPE, Lockout, Non-Routine, etc.)
Could any of these practices/conditions observed result in property damage, personal injury or illness? If "Yes", describe.
Were the methods and practices the most efficient and productive? If "no", describe.
Did the practice observed comply with all of the applicable procedures or standards that exist for this task? If "no", describe.
Did you observe any practices or aspects of the task that were improvements which deserve recognition? If "Yes", describe.
Clearly describe any practices that deserve Compliment or Correction:
Have you complimented or reinstructed the worker on these observations?
Should a follow-up observation of the worker/task be made in the near future? If "Yes" describe why.
Describe any standard procedure, method or equipment that you observed and feel that management should consider changing in the interest of safety or productivity.