Employee Name

Date of Evaluation

Department

Maintenance

Evaluator’s Name

Criteria

Compliant

Comments

Proper use of Personal Protective Equipment (PPE)

✓

Regularly uses safety goggles and gloves.

Adherence to safety signage
and instructions

✓

Always mindful of warning signs.

Proper handling and storage
of hazardous materials

✓

Ensures materials are stored in designated places.

Knowledge of emergency
evacuation procedures

✗

Uncertain about the secondary exit route.

Regular safety drills participation

✓

Participated in all scheduled drills.

Use of safe practices around machinery/equipment

✓

Demonstrates care when operating machinery.

Reporting hazards and
incidents promptly

✗

Failed to report a minor spill last month.

Completing mandatory safety training

✓

Completed recent safety course on time.

Overall Rating

• Exceeds

Expectations

• Meets

Expectations

• Needs

Improvement

Comments & Recommendations

Employee generally adheres to safety guidelines and practices. However, it's crucial that employee remains proactive in reporting all hazards and refreshes knowledge on evacuation routes. Recommend a quick refresher course to address these gaps.