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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