HEALTH & SAFETY COMMITTEE MEMBER EVALUATION FORM

Please rate the Committee Member's performance in the following categories on a scale of 1 to 5, with 1 being "Poor" and 5 being "Excellent."

Name:	[Name]	Department:	[Human Resources]
Position:		Employee ID:
Tenure:		Evaluation Period:

Criteria	Rate
Attendance and Participation	5
Contribution to Health & Safety Initiatives
Knowledge of Health & Safety Regulations
Communication Skills
Teamwork and Collaboration
Initiative and Problem-Solving

Comments and Feedback

Please provide comments and feedback on the Committee Member's performance during the evaluation period:

The members were all helpful in giving their insights.

Recommendation

Based on the evaluation, please indicate your recommendation regarding the Committee Member's continued membership on the Health & Safety Committee:

Evaluator Signature:

[Your Name]

[Job Title]

[Month Day, Year]

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