SAFETY PROGRAM AND TEST EQUIPMENT EVALUATION Department: Date: Name: Title: Reports to: Rank/Grade: I have reviewed the tasks listed below and have identified by initial my competency level for each of the indicated areas. Whenever my initialed level is below the expectation level as indicated on the evaluation, additional training may be scheduled and listed on my individual development plan as resources permit. This evaluation will be kept in my training folder and may be reviewed at any time. TASK EXPECT COMP/INIT Department-specific policies and procedures 2 Confined Space 2 Lockout/Tagout 2 Ladder Safety 2 Standard precautions/infection control 2 Hazard Communication 2 Noise 2 Respiratory Protection 2 Personal Protective Equipment (PPE) 2 Technical policies, procedures, and standards 2 Use of test equipment Standard test equipment devices 3 (List specific test equipment)
SAFETY PROGRAM AND TEST EQUIPMENT EVALUATION Department: Date: Name: Title: Reports to: Rank/Grade: I have reviewed the tasks listed below and have identified by initial my competency level for each of the indicated areas. Whenever my initialed level is below the expectation level as indicated on the evaluation, additional training may be scheduled and listed on my individual development plan as resources permit. This evaluation will be kept in my training folder and may be reviewed at any time. TASK EXPECT COMP/INIT Department-specific policies and procedures 2 Confined Space 2 Lockout/Tagout 2 Ladder Safety 2 Standard precautions/infection control 2 Hazard Communication 2 Noise 2 Respiratory Protection 2 Personal Protective Equipment (PPE) 2 Technical policies, procedures, and standards 2 Use of test equipment Standard test equipment devices 3 (List specific test equipment)