<p> Form 000.653.F0218j Performance Evaluation – Construction Equipment Operator: Farm Tractor</p><p>Name (last, first, middle initial) Personnel/Social Security/ID No. Craft and Position front Project No./Contract No. Project Name Badge No. For Office Use Only Overall Rating</p><p>Instructions to Evaluator/Licensor Designate the level of achievement for each factor by circling the appropriate number. Do not let your appraisal of one factor influence your appraisal of another. Be objective; do not allow personal feelings to govern your appraisal of the employee. Each factor to be appraised has 5 levels of achievement by which it may be measured with 1 being the lowest rating and 5 being the highest rating. The rating n/a means that the item is not applicable to the machine operation.</p><p>Performance Factors General: Circle Appropriate Performance Rating LOW HIGH 1. Demonstrates safety awareness 1 2 3 4 5</p><p>Specific: 2. Quality of work. 1 2 3 4 5 3. Read and use operator’s manual. n/a 1 2 3 4 5 4. Identify safety equipment on the equipment. n/a 1 2 3 4 5 5. Read and use all capacity charts for equipment. n/a 1 2 3 4 5 6. Identify components and controls of equipment. n/a 1 2 3 4 5 7. Learn and observe rigging operations. n/a 1 2 3 4 5 8. Perform daily service and maintenance of equipment. n/a 1 2 3 4 5 9. Perform machine setup for operation. n/a 1 2 2 4 5 10. Perform basic operation of equipment. n/a 1 2 3 4 5 11. Perform full/complex operation of equipment. n/a 1 2 3 4 5 12. Perform general cleanup of equipment n/a 1 2 3 4 5 13. Overall evaluation. 1 2 3 4 5 Comments</p><p>Prepared By Evaluator/Licensor (print) Signature Date</p><p>Reviewed By Immediate Supervisor (print) Signature Date</p><p>Employee (print) Signature Date</p><p>By signing this form, the employee acknowledges that it has been reviewed with him/her. Signature does not necessarily signify agreement.</p><p>Note: This form is referenced in Practices 000.653.3200 and 000.653.3203.</p><p>Copyright © 2010, P2S. All Rights Reserved. Page 1 of 1 Health, Safety, and Environmental Form Date: 01Feb2010</p>