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Supervisors Review Rating Sheet For Safety Performance (Circle Appropriate Evaluation Points For Performance)

This document contains a rating sheet to evaluate a supervisor's safety performance. It assesses areas such as conducting safety meetings and inspections, completing injury reports, and demonstrating a commitment to safety. Supervisors are scored on a scale of 0-4 in each area, with higher scores indicating better performance. The total score translates to an overall performance level that determines the percentage of the supervisor's review based on safety.

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Ronak Mota
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208 views1 page

Supervisors Review Rating Sheet For Safety Performance (Circle Appropriate Evaluation Points For Performance)

This document contains a rating sheet to evaluate a supervisor's safety performance. It assesses areas such as conducting safety meetings and inspections, completing injury reports, and demonstrating a commitment to safety. Supervisors are scored on a scale of 0-4 in each area, with higher scores indicating better performance. The total score translates to an overall performance level that determines the percentage of the supervisor's review based on safety.

Uploaded by

Ronak Mota
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Supervisors Review Rating Sheet for Safety Performance

(Circle Appropriate Evaluation Points for Performance)


Rating Items: 0 None or N/A; 1 Adequate; 2 Average; 3 Excellent; 4 Distinguished Performance Ratings

1. SAFETY MEETING/ SAFETY TRAINING

Does the supervisor conduct a safety meeting each month for his/her department? 0 1 2 3 4
Does the supervisor attend a department or plant safety meeting each month? 0 1 2 3 4
Does the supervisor attend training programs such as first aid, CPR, forklift, etc.? 0 1 2 3 4
Does the supervisor give new or transferred employees a safety orientation? 0 1 2 3 4

2. SAFETY AND HEALTH INSPECTIONS

Is the supervisor conducting monthly safety/ health inspections? 0 1 2 3 4


Is the proper inspection form being used? 0 1 2 3 4
Are unsafe actions or conditions being corrected as soon as possible? 0 1 2 3 4
Are work orders for corrective action being submitted? 0 1 2 3 4

3. JOB HAZARD ANALYSIS (JHA)

Is one JHA completed each quarter? 0 1 2 3 4


Are employees participating in each JHA? 0 1 2 3 4
Is quality of JHA meeting company standards? 0 1 2 3 4

4. INJURY INVESTIGATION

Are the forms completed and submitted within 24/48 hours? 0 1 2 3 4


Are the forms completely filled out on company form? 0 1 2 3 4
Have recommendations for corrective action been completed? 0 1 2 3 4
For zero injuries, has a simulated report been completed? 0 1 2 3 4

5. INCIDENT/ NON-INJURY REPORTS

Are significant incidents being investigated? 0 1 2 3 4


Is the completed incident form being submitted with a photo? 0 1 2 3 4
Is corrective action taken on each incident? 0 1 2 3 4

6. SUPERVISOR'S SAFETY ATTITUDE

Does the supervisor demonstrate a sincere interest in his/ her employee's safety? 0 1 2 3 4

DATE: Total Scoring: Scoring Key


30-48 Points = Adequate @ 5 % of Review

Name of Supervisor: 49-55 Points = Average @ 10% of Review

56-63 Points = Excellent @ 15 % of Review

Signature of Manager: 64-72 Points = Distinguished @ 20% of Review

Facility:

Overall Point/ Performance Total:

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