Scribd
Upload
3K views1 page

Employee Safety Performance Evaluation Form

Uploaded by

DLPS HSE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
3K views1 page

Employee Safety Performance Evaluation Form

Uploaded by

DLPS HSE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Employee Safety Performance

Evaluation Form
DLPS-HSE-037/00

Employee Name: ____________________________________ Employee No.: _________________


Designation: ________________________________________ Direct Supervisor: _________________
Project: ____________________________________________

GENERAL 5 4 3 2 1 NA

Keeping the provided PPE clean and worn at site.

Attending Safety Meeting and Toolbox.

Properly uses tools and equipment


Initiating Housekeeping at work. Maintaining work area organize and
clean.
Participating in Safety Activities such as drills and others.

Participating Safety Observation Reporting

Participating in Near miss Reporting

FOR SUPERVISOR 5 4 3 2 1 NA

Treats Subordinates with respect, dignity and tactfulness while carrying


out all responsibilities
Works cooperatively with subordinate

Conveys orders in a manner that is clear and concise

Follow Permit Working Procedures

EVALUATOR
Name & Signature Name & Signature

Designation: Designation:

Date: Date:

Comments: Comments:

You might also like