Health & Safety Committee Performance Evaluation

Please complete each section of the form to evaluate the performance of the committee. Provide a rating of 1-5, 1 for Poor and 5 for Excellent, on some statements.

EVALUATOR INFORMATION

Name: [Your Name]	Date: [12/14/2056]
Position: [General Manager]	Number: [222 555 7777]

PERFORMANCE RATING

Items	5	4	3	2	1
Frequency of Meetings	✔
Quality of Meeting Agendas
Participation and Engagement
Identification of Workplace Hazards
Effectiveness of Risk Assessments
Documentation of Risk Assessments
Policy Development and Updates
Compliance with Regulations
Effectiveness of Training Programs
Communication Strategies

Comments/Suggestions
1	[The committee had exceptionally followed industry best practices]
2
3

VERIFICATION

I, [Your Name], hereby certify that the information and assessments provided in this Evaluation accurately reflect my observations and judgments. I have conducted this evaluation fairly and in accordance with established criteria. 

Date: [MM/DD/YY]

Thank you for your dedication to maintaining a safe and healthy work environment.

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