Competency Assessment & Performance Review
EDIT NOTES:
Ensure to alter second table to match position-specific tasks (Refer to company JTI)
Who is completing this form?
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Supervisor/Manager
Worker
Please Select
Name of worker being evaluated
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First Name
Last Name
Position
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Review Period:
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Date Range
Review & Evaluation:
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Failure to meet Requirements
Requires Improvement
Meets Requirements
Meets and Occasionally Exceeds Requirements
Regularly Exceeds Requirements
Not Applicable
On The Job Training Up to Date & Complete
Qualifications Verified to Perform Roles
Demonstrates Required Job Skills and Knowledge
Has the Ability to Learn and Use New Skills
Uses Resources Available in an Effective Manner
Responds Effectively to Assigned Responsibilities
Listens to Direction From Management
Takes Responsibility for Actions
Honours Commitments
Demonstrates Problem Solving Skills
Offers Constructive Suggestions For Improvement
Generates Creative Ideas and Solutions
Meets Challenges Head-On
Demonstrates Innovative Thinking
Equipment Care and Handling
Attendance/Punctuality
Follows Safety Practices
Competent to Perform Assigned Tasks
Competent to Operate ATV
Competent to Operate Vehicle
Competency Evaluation of Safe Work Procedures:
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Failure to meet Requirements
Requires Improvement
Meets Requirements
Meets and Occasionally Exceeds Requirements
Regularly Exceeds Requirements
Not Applicable
ATV Operation
Axe Use
Calibration and Use of Gas Detectors
Chainsaw Operation
Communicate with Landowners, Project Managers, Consultants, Employees
Crossing Water Bodies
Equipment Loading/Unloading (UTV, ATV, Snowmobile)
Excavating, Digging a Trench or Ditch
Flagging
Helicopter Safety
Installing Legal Post, Marker Post, Lathes
Lifting Techniques (Manual Material Handling)
Locate Buried Facilities
Machete Use
Pulling Legal Posts
Sledgehammer Use
Snowmobile Operation
Vehicle Operation
Walk Over Rough Steep Terrain
Walk Over Rough Terrain
Winch Operation
Working Alone
Working Along Roadways
Working Around Heavy Equipment
Working Around Hydrogen Sulphide (H2S)
Working Around Wildlife
Working in and around Moving Water
Working in and Around Still Water
Working in Cold Weather
Working in Congested Areas
Working in Hot Weather
Working in Remote Sites/Areas
Working Near Overhead Powerlines
Working Near Unattended Stations
Working on Ice
Has this worker missed work for any reason other than scheduled vacation days?
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Yes
No
Total days absent from work:
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Has this worker been involved in any incidents with this company?
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Yes
No
Select all types of incidents the worker has been involved in:
Injury
Spill
Vehicle Accident
Property Damage
Equipment Damage
Workplace Violence
Loss of Productivity
Other
Did these injuries result in a WCB claim?
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Yes
No
What type of WCB Claim?
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Lost Time
Modified Duty
Medical Aid
Other
Describe incidents they have been involved in:
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Number of vehicle accidents:
Leave blank if none
Overall Performance Rating
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Failure to meet Requirements
Requires Improvement
Meets Requirements
Meets and Occasionally Exceeds Requirements
Regularly Exceeds Requirements
Not Applicable
Overall Performance
For any items that do not meet requirements, please describe the plan being developed for the worker to address these deficiencies:
Additional Remarks:
Supervisor Approval
Supervisor/Manager
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First Name
Last Name
Date Signed
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Month
-
Day
Year
Date
Email of Supervisor/Manager
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example@example.com
Supervisor/Manager Signature:
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WORKER USE ONLY: If you are the worker this Competency Assessment & Performance Review was completed for, please click yes below to proceed to the Worker Sign Off & Approval Page
Yes
Worker Approval
Upon review of the above evaluation, please select one:
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By signing below, I have reviewed, understand and agree with the above evaluation.
By signing below, I am confirming receipt of performance appraisal, but do not agree with the above evaluation.
Please provide information on why you do not agree with the above evaluation.
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Worker Name:
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First Name
Last Name
Date Signed:
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-
Month
-
Day
Year
Date
Worker Email:
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example@example.com
Worker Signature:
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Submit
Should be Empty: