Refractory Evaluation Form
Personal Information
Name
*
First Name
Last Name
I am an
*
Helper
Finisher
Setter
Apprentice
Improver
Management
Email
*
Confirmation will be sent here
Phone Number
*
-
Area Code
Phone Number
Work Performed
Wk 1
Wk 2
Wk 3
Wk 4
Wk 5
Brick
New Work
Repair
Saw
Castable
Ramming
Gunning
Hot Work
Labor/Other
Brick Total
New Work Total
Repair Total
Saw Total
Castable Total
Ramming Total
Gunning Total
Hot Work Total
Labor/Other Total
Combined Monthly Total
Job Information
Month & Year Worked
Work Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Rate %
Work Phone Number
-
Area Code
Phone Number
Comments
Employer/Contractor
Foreman's Name
Ratings
Skill Level
Needs improvement
Acceptable
Outstanding
Comments
Performance Level
Needs improvement
Acceptable
Outstanding
Comments
Cooperation Level
Needs improvement
Acceptable
Outstanding
Comments
Safety Level
Needs improvement
Acceptable
Outstanding
Comments
Motivation Level
Needs improvement
Acceptable
Outstanding
Comments
Attendance/Tardies
Needs improvement
Acceptable
Outstanding
Comments
Submit Report
Should be Empty: