Employee Safety Performance Review Form
Name of Employee Being Reviewed
First Name
Last Name
Your Name
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Review Period
Q1
Q2
Q3
Q4
Annual
New Employee
Department
Melt
Maintenance
Forge
Induction
Machine
Other
Evaluation
Rows
Exceptional
Exceeds Requirements
Meets Requirements
Unsatisfactory
Is the employee fit for duty? (Signs of illness, other)
Yes
No
Yes
No
Yes
No
Yes
No
Is PPE being worn according to assignment? (Hard hat, safety glasses, etc.)
Yes
No
Yes
No
Yes
No
Yes
No
Have all hazards been identified and documented?
Yes
No
Yes
No
Yes
No
Yes
No
Does the employee practice good housekeeping?
Yes
No
Yes
No
Yes
No
Yes
No
Is the employee using the right tools for the job?
Yes
No
Yes
No
Yes
No
Yes
No
Have all hazards been abated (removed) prior to work?
Yes
No
Yes
No
Yes
No
Yes
No
How would you rate the quality of the employee’s work?
1
2
3
4
5
6
7
8
9
10
Additional Comments
Signature
Type a question
Submit
Should be Empty: