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Performance Appraisal Form

SAFETY OFFICER

Name: _______________________________ Period: ____________________________

Basic Work Responsibilities

1. Takes lead in day-to-day implementation of safety.


a. In charge of planning the activities for the day/week.
2. Conducts toolbox meeting and ensures that all information are cascaded to all
concerned.
3. Takes charge of manning:
a. Ensures that daily manning is sufficient to guaranty safe distribution of task or
based on set standards.
b. Takes lead in Safety Programs in coordination with HR and Safety Head.
4. Coordinates with “CONTRACTOR” operations and works hand-in-hand with
“SUBCONTACTOR”
5. Prepares and submits on time all required Safety and Health Reports.
6. Continues to create or improve Safety and Health Checklists
7. Takes lead in the implementation of Safe Work Procedures for“CONTRACTOR”.
8. Ensures that Safety and Health Procedures has met the standards set by
“CONTRACTOR”.
a. Authorizes Review of Standard Procedure if fails to meet standards on the safety
inspection.

Rating Degree Rating Score

Superior 5
Satisfactory 4
Needs Improvement 3
Below Average 2
Does not meet requirement 1

1
Part 1: Appraisal of Basic Work Responsibilities
Key Result Area Score Remarks
1. Safety Inspection (is there a
systematic plan employed in the
day-to-day safety inspection)
2. Quantity and Clarity of reports
(are the required reports
submitted on time)
3. Cycle time – the ability to start
and finish the job on time
without the need for a follow-up

4. Knowledge - Adherence to SWP


5. Adherence to Safety Standards
and Compliance Reports
Score (total/5) __________

Part 2: Adherence to Corporate Values


Corporate Value Score Remarks
1. Leadership
2. Initiative (does things
independently without the need
of further coaching from
superiors)
3. Dependability / Industry
4. Attitude towards work – follows
Code of Discipline; No violation
record
5. Attendance / punctuality
6. Promotes teamwork. Works
harmoniously with all the
integral member of the team –
team leaders, safety supervisors,
safety officers and workers

Score (total/5) __________

Part III: Appraisal of Over-all Performance


Particulars Score % Weight Weighted Score
2
1. Total weighted score for part I 50%
2. Total weighted score for part II 50%
Over-all performance appraisal score 100%
Equivalent Rating Degree ___________

Part IV: Performance Discussion


Supervisor’s Observation Employee’s Response

______________________________ _______________________________
Name and Signature of Rater Name and Signature of Ratee

______________________________
Date of Discussion

Noted by:

______________________________ _______________________________
Name and Signature Name and Signature

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