Commentary Task Assessment

Form is for use by qualified Commentary Task Coaches (CTC), Level 3, or Level 4 Instructors ONLY

Version 1.0, Jun 2006

Owner - Guy Lombardo (Global Injury Prevention Manager)

Area : Area
Geomarket : GM
Country : CNT
Location : LOC
Assessment Date : Date
Location Manager Name : Manager
Assessor's Name : Assessor
Assessed Person's Name : Assessed
Assessed Person's Direct Supervisor's Name : Supervisor
Schlumberger Injury Prevention Program
Commentary Task Assessment Form January 2006 Appendix 6

One Employee / Multiple Activities

Use Multiple Sheets if Necessary

Assessed Person's Name Assessed

Assessed Person's Direct Supervisor's
Name Supervisor
Assessment Date Date
Location LOC
Assessor's Name Assessor
List the Activity(ies) or Task(s) Observed during this Commentary Task Assessment :

Pre-Assessment Observations
Warm Up Done?
Activity Necessary? (Y/N) Risk Assessment Done? (Y/N) PPE Appropriate? (Y/N/NA)
(Y/N)

Total Safe Observations Total At-Risk Observations % Safe Behavior Comments

(Notes on Interventions,
for this Technique for this Technique (=[A/(A+B)] x Motivational/Formative Feedback, Risk
(A) (B) 100) Identification etc.)

When completing the paper form, count observations using tally marks as follows
Principle SIPP Techniques When completing the forms electronically for upload to QUEST type in a number (ie 5)

Line of Strength

Side Stepping

Safe Working Zones

Smart Grip

Watch Your Head

Bracing & Spinal Alignment

When completing the paper form, count observations using tally marks as follows
Special SIPP Techniques When completing the forms electronically for upload to QUEST type in a number (ie 5)

Stairs Technique

Climbing 3-Point

Team Carry

MechLift Decisions

Crew Interventions

Overall Totals

% Overall Safe Behavior this

Commentary Task Assessment

% Overall Safe Behavior on previous

Commentary Task Assessment

Evaluation Results Next Commentary (Circle applicable option)

Good working habits 1 year from now
Needs some improvement 3 months from now
Needs significant improvement 2 weeks from now
 Template for import of remedial actions in QUE
Action Item Summary Comments
(limited to 50 characters) (limited to 255 characters)
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dial actions in QUEST
Priority Responsibility Target Date Close Date
(H, M or L) (GIN Number Or LDAP Alias) (Date) (Date)
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M

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