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<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
d) Other: ___________
□ Physical Demands Analysis
□ Other: ___________________
***Please indicate which method was used to assess the □ Other: ___________________
employee’s competency within each skill category.

Task Component Methodology Comments / Decisions Date

Employee Signature: Date:

Assessor Signature: Date:

Competency Checklist
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