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Employee Safety Performance Review Form Template

Streamline your safety performance evaluations with this template

Evaluating employee safety can be challenging when you lack the right tools to measure success. This template is designed for managers who want to conduct comprehensive safety performance reviews, ensuring employees are accountable for their safety practices. Benefit from clear performance indicators, tailored feedback phrasing, and improved employee engagement, all while ensuring compliance with safety standards. Experience an easy-to-use format for effective assessments-try out the live template now!

Employee full name
Job title
Department or team
Reviewer full name
Review period start date
Review period end date
Completed all required safety training for this role during the review period
Yes
No
Training or certification needs identified (select all that apply)
None
Refresher on existing procedures
New certification required
Coaching or mentoring
Other
Please Specify:
Follows standard operating procedures and permit requirements
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Uses required personal protective equipment (PPE) correctly and consistently
Very rarely
Rarely
Sometimes
Often
Very often
Conducts pre-task risk assessments or JSAs before work
Very rarely
Rarely
Sometimes
Often
Very often
Reports hazards and near misses promptly
Very rarely
Rarely
Sometimes
Often
Very often
Stops or refuses work when conditions are unsafe
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Describe any incidents or near misses and the corrective actions taken (enter N/A if none)
Recordable injury, illness, or property damage occurred during this period
Yes
No
Communicates safety concerns promptly and respectfully
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Overall safety performance for this review period
Poor
Fair
Good
Very good
Excellent
Top safety strengths observed
Goals or actions for the next period (use clear, measurable targets where possible)
Employee typed signature (enter full name)
Reviewer typed signature (enter full name)
Acknowledgement date
I have reviewed this assessment with my manager
Yes
No
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Paper art illustration depicting an employee safety performance review form template for FormCreatorAI.

When to use this form

You can use this form during quarterly or annual reviews, after a near miss, and when onboarding employees who work around hazards. Supervisors and safety managers use it to capture specific behaviors, rate compliance, and agree with you on training and corrective actions. You get clear feedback and a fair, evidence-based score tied to real tasks. It is also helpful before shutdowns or major projects to confirm readiness and assign owners. During walk-throughs, pair the review with the Hazard identification checklist form to verify conditions on the floor. To align goals with facility risks, review results from the Fire risk assessment form so your plan targets the highest hazards first.

Must Ask Employee Safety Performance Review Questions

  1. Which safe work practices did you follow consistently this period, and where can you improve?

    This prompts concrete examples instead of vague claims, so you can rate behaviors fairly. It also surfaces gaps you can turn into a short action plan.

  2. Describe one recent hazard you identified and how you controlled or reported it.

    This links choices to outcomes and shows whether you apply the hierarchy of controls. It also reveals how quickly you act and whether you use company channels.

  3. Were there any near misses, incidents, or violations involving you or your area? What corrective actions followed?

    The answer helps you verify reporting discipline and track closure. If a case needs follow-up, attach the Employee safety violation form.

  4. How prepared are you for emergencies such as fire, spill, or medical events?

    Readiness reduces harm when seconds matter. Use the Contingency plan checklist form to confirm drills, contacts, and equipment are up to date.

  5. What training, tools, or process changes would help you and your team work more safely next quarter?

    This turns feedback into clear next steps you can budget and schedule. It also creates measurable goals you can revisit in the next review.

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