CHIEF WARDEN DETAILS
NAME: / STAFF ID#:
POSITION TITLE: / DEPARTMENT:
BUILDING DETAILS
BUILDING NAME: / BUILDING CODE:
This review covers the period from: to
REVIEW
YES / NO / PERFORMANCE CRITERIA / EVIDENCE REQUIRED
Maintain an up-to-date Emergency Procedure Document / Copy of current document – it must the consistent with the Proforma Emergency Procedure Document and updatedwithin previous 6 months.
Maintain greater than 75% Warden Membership / More than 75% of the warden positions identified in the Emergency Procedure Document have been filled.
Chair and minute a minimum of two Emergency Control Organization (ECO) meeting. / Copies of meeting minutes.
Regularly report to the local Head(s) of Department on Building Emergency Management issues (minimum of two communications). / Emails, notes, reflection on direct experience etc.
Respond to building emergencies. / Observation discussion.
Complete an emergency evacuation checklist for each evacuation and submit this to OHS & Injury Management. / Copies of recent Emergency Evacuation Checklists.
Liaise with OHSIM, Security and CIS on emergency issues. / Copies of emails, CIS Work Requests relating to Fire Systems etc.
Where necessary, complete a planned annual evacuation exercise. / Copy of the Emergency Evacuation Checklist.
If all of the performance criteria have not been met, the Chief Warden must be provided with feedback and given opportunity for a second review withina 3 month period. Please complete this form again following the second review.
REVIEW OUTCOMES& REVIEWER DETAILS
I confirm that I am the Head of Department for the nominated Chief Warden and that I have sighted and kept a record of the supporting documentation in relation this review.
□ Please pay the agreed Chief Warden Bonus.
□ Position confirmed for the next 12 months. / □ Performance criteria not met. Second review pending.
□ Performance criteria not met during second review. No bonus.
NAME: / POSITION TITLE:
DEPARTMENT: / Bonus to be funded from (Account #):
SIGNATURE: / DATE:
CHIEF WARDEN
I agree/support that my performance has been fairly and objectively reviewed against the above review criteria.
SIGNATURE: / DATE:
Submit by email to Work Health & Safety Services:
Keep a copy in a secure local file.