Situation • Behavior • Impact

Feedback Form

Team member name: Joseph C. Aquino Date of feedback:

March 30, 2023

Preparation
Record your observations and thoughts below to help you prepare to give a team member feedback.

Situation: Last tuesday, March 28,2023, the Secondary Crusher 2 shutdown due to severe oil leaking at its
main crusher frame. Upon inspection, it was determined that a severe crack in the frame was found
which propagated to the entire body of the main frame. However, before the unplanned equipment
shutdown, you have conducted an equipment inspection and already observed the hair line crack but
failed to report the equipment status/situation.

Behavior: During the situation, you have displayed a negligent behavior. The failure to
properly report the equipment status have further worsened the situation.

Impact: The negligent behavior have caused production lossess and further
damaged to company property

Reflection
After you have given the team member your feedback, use the space below to reflect on how it went,
and how you might develop your feedback skills further.

What went well?

Joseph listened very well and fully accepted the misbehavior that he have shown. He was
apologetic and accepted the necessary disciplinary action as a consequence of his
behavior.
What didn’t go so well?
At first, he was hesitant and he was mad. But after stating the facts and showing the
proof of negligence, he was able to accept and apologize.

What could I do differently in future?

I could have given the feedback in a more lighter and calm manner. Its also important
to consider the timing of the feed back session since Mr. Aquino came from a night
shift duty.

Please feel free to copy this sheet for your own use and to share with friends,
co-workers or team members, just as long as you do not change it in any way.
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