M4E Worker Competence Evaluation - Rev 1

Worker Competency Evaluation

Supervisors Observation

Parramatta Road Surface Works / Civil

• Conducted on

  Date

Plant / Equipment or Task Type

Plant / Equipment Make and Model

Worker Details - Full Name

Employer Details

Project / Site

• WestConnex M4E Stage B - Parramatta Road - Surface Works

Observation Location

• 150 - 200 Parramatta Road, Ashfield, NSW
  Address

• A copy of the relevant SWMS or any other determined associated hazard control document should be used during this Observation. Each task / step should be reviewed for compliance wit the agreed work methodology and associated hazard controls.

Task / Step Observations

• The worker demonstrated correct pre-start inspection for plant, attachments or high risk work equipment, and recorded the inspection as required

  Yes

  No

  N/A

• The worker demonstrated an ability to isolate plant, correctly use, fit and maintain attachments or equipment where required

  Yes

  No

  N/A

• The worker demonstrated an ability to perform within limitations of plant, attachments or high risk equipment.

  Yes

  No

  N/A

• The worker demonstrated an ability to work in accordance with safe systems of work and or other control documents

  Yes

  No

  N/A

• The worker demonstrated the ability to maintain Working Loads and perform calculations, as required.

  Yes

  No

  N/A

• Does the worker require further Information, Training, Supervision or Instruction

  Yes

  No

  N/A

Any Corrective Actions

• Corrective actions Required

• Corrective Actions - Assigned to

The worker was observed performing the following work activities or steps

Worker Competence – Supervisor Observation Outcome

• The worker met or did not meet the required standard(s)

  Yes

  No

  N/A

Supervisors Name

• Add signature

  Sign

Content Expert (Where applicable)

• Add signature

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