Commentary Task Assessment Form

Completed and signed CTA form shall be kept by Assessor for at least 12 months and available for submission upon any request.
Assessor is accountable for keeping the CTA Forms.

Assessed Person's Commentary Task

Name Coach's name

Assessment Date Location

List the Activity(ies) or Task(s) Observed during this Commentary Task Assessment:

Pre-Assessment Observations
No Jewelry&
Risk Assessment Warm Up Appropriate Right tool dangling
Done? Done? PPE worn? used? clothing?
Y N Y N Y N Y N Y N

Total Observations for this

SIPP Technigues Technique Comments on Interventions, Motivational/Formative Feedback,
Risk Identification)
Principle SAFE AT RISK

Line of Strength

Side Stepping

Safe Working Zones

Smart Grip

Watch Your Head

Bracing & Spinal

Alignment

Special

Stairs Technique

Climbing 3-Point

Team Carry

Crew Intervention

Mechanical Lifting
Decisions

> CTA Passed Update CTA Certification in QUEST

TOTAL SCORE or
Notify Location HSE & Supervisor.
CTA Failed
< Assessed person to schedule an additional CTA

Assessed person's Assessor's

signature signature

# Schlumberger-Private