Eval Summary

  • Contractor

  • Contact Name

  • Contact Number

  • Contractor Activities

Evaluation Summary

  • Questionnaire Received

  • Documentation Reviewed

  • Documentation Requested

  • Documentation Received

  • Contractor Interviewed

  • Contractor Accepted

Eval Criteria

Evaluation

  • Loss Experience below Industrial Average

  • TRR/DART (past 3 yrs)

  • Experience Modification Rates (1 or below)

  • EMRs (past 3 yrs)

  • OSHA Activity

  • Comments

  • Safety Program

  • Comments

  • Field Safety Inspections

  • Comments

  • Staff Professionals

  • Comments

  • New Hire Orientation

  • Comments

  • Training Programs Adequate

  • Comments (list key training needing completed)

  • Disciplinary Procedures

  • Comments

  • Accident Investigations

  • Comments

  • HAZCOM

  • Comments

  • Toolbox Talks/safety talks

  • Comments

  • Drug Free Program

  • Comments

  • Safety Planning (AHA/JHA/THA)

  • Comments

  • Certificate of Insurance

Eval Criteria

  • Summary

  • Health & Safety Manager

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