<Insert Your Logo Here>

<company>COMPETENCY CHECKLIST

Employee Name: Position:

Task Assessed for: Department:

Assessor Name:

Methodology use to assess: Location of Resource Material used for training:

a) Direct Observation with checklist □ Manufacturer’s Documentation
b) Demonstration □ Formal Hazard Assessments
c) Self-study with test □ Physical Demands Analysis
d) Other: ___________ □ Other: ___________________
□ Other: ___________________
***Please indicate which method was used to assess the
employee’s competency within each skill category.

Task Component Methodology Comments / Decisions Date

Employee Signature: Date:

Assessor Signature: Date:

Competency Checklist
Page 1