TVC 5a. Lifeguard Performance Assessment

• Lifeguard Name Who You Are Observing

• Conducted on

  Date

• Completed By

Performance Assessment Information

• Full Name Of Lifeguard: -

• Activity Within Pool At Time Of Assessment: -

• Observed From

  Date

• Observed Until

  Date

• Quarter Observed In

  Jan-Apr

  May-Aug

  Sept - Dec

  Induction LPA

  Ad Hoc LPA

Visual Observation - Any No's - Provide Details

• Which Site Are You Completing The LPA

  Andover Temporary Pool

• Lifeguarding Position At Time Of KPI

  MP1

  MP2

  TP

• Lifeguarding Position At Time Of KPI

  MP1

  MP2

• Are they in the correct lifeguarding location?

  Yes

  No

• Are they standing straight / sitting upright?

  Yes

  No

• Are they wearing or within reaching distance of a torpedo buoy?

  Yes

  No

  N/A (Slide Only)

• Is the lifeguard wearing the correct uniform?

  Yes

  No

• Are they adopting the correct change over / rotation?

  Yes

  No

• Are they wearing only appropriate jewellery?

  Yes

  No

• Did they intervene appropriately in any incident/hazard?

  Yes

  No

  No Incident

• Are they wearing the correct uniform?

  Yes

  No

Non-Visual - Any No's - Provide Details

• Are they aware of the zone they are responsible for when asked?

  Yes

  No

• Are they in possession of a whistle?

  Yes

  No

• Are they aware of their responsibilities as the Lifeguard in that position?

  Yes

  No

Completion

• Date & Time Completed

  Date

• Ensure this is completed on the excel spreadsheet
  Ensure the PDF is saved onto the QMS

• Type Name & Sign

  Sign