SAFE WORKER ASSESSMENT CRITERIA

Date: ______________________
Project Title: Contract / CRC No.:

Name of the Employee Recommended: Employee No.:

Trade: Length of Service in Site: Period Covered:

Recommended by: Designation:

Nominated by: Designation:

(Management Staff)
Grading / Descriptions / Score
A B C D E
Very Very
SN ASSESSMENT CRITERIA Good Good Fair Poor Poor Total
10 9 8 7 6 5 4 3 2 1
1. Wearing of PPE
Obeying of HSE
2.
Instructions
Attendance for daily Tool
3. Box Meeting /Job safety
instructions
Attendance for Weekly
4.
HSE Talk Demonstrated
5. HSE Contribution
Co-operation with other
6.
workers
Able to encourage other
7. workers to follow HSE
rules
8. Good Housekeeping habit

9. HSE Awareness Proactive

10. Positive working attitude

TOTAL

Assessed by: Designation:

Date: Signature:

Remarks: ________________________________________________________________________________________________

Distribution: HSE Dept. Manager Project Manager Project HSE Staff

Revision No. 05 Page No. 1 of 1 Doc. No. IS-HSE-R40

Prepared by: Management Representative Issued Date: 21st January 2018
Reviewed by: General Manager Approved by: Chief Executive Officer