Using the Worksheet

At the end of this booklet, you will find Worksheet 2: Sample Evaluation Formats. These formats are provided to show you some of the different ways you can evaluate different kinds of objectives.

For example, Sample Objective #1 deals with employee attitudes and beliefs. A good way to learn about people's attitudes is to ask them direct questions, such as those in the three Sample Questionnaire Items provided. When you write your own questionnaires, make sure that each attitude or belief is clearly stated and that you give employees a range of responses to check or circle.

Sample Objective #2 deals with hard financial data related to company expenditures over a target time period. The best way to collect this data is with a written data collection form. Use the same form whenever you collect data, so that you can easily compare findings from different time periods.

Sample Objective #3 deals with actual employee behaviors. The best way to measure this kind of objective is through real-life observations. To help you make and record accurate observations, use a written form like the one shown on the worksheet.

See Step #2 on how to use this worksheet.

Direct Costs	Cost
Workers' compensation benefits	$______
Healthcare costs for off-duty injuries	$______
Increases in medical insurance premiums	$______
Auto insurance and liability claims and settlements	$______
Physical and vocational rehabilitation costs	$______
Life insurance and survivor benefits	$______
Group health insurance dependent coverage	$______
Property damage (equipment, products, etc.)	$______
Motor vehicle repair and replacement	$______
TOTAL	$______
Indirect Costs	Cost
Supervisor 's time (rescheduling, making special arrangements)	$______
Fleet manager 's time to coordinate vehicle repair, replacement, etc.	$______
Reassignment of personnel to cover for missing employees (less efficiency)	$______
Overtime pay (to cover work of missing employees)	$______
Employee replacement	$______
Reentry and retraining of injured employees	$______
Administrative costs (documentation of injuries, treatment, absences; crash investigation)	$______
Inspection costs	$______
Failure to meet customer requirements resulting in loss of business	$______
TOTAL	$______

See Step #6 on how to use this worksheet.

Sample Objective #1: Employees will demonstrate attitudes and beliefs that foster compliance with motor vehicle safety regulations.

Sample Questionnaire Items

1. Posted speed limits should be followed exactly.
Strongly Agree Agree Disagree Strongly Disagree

2. It is safe to drive after drinking alcohol as long as you drive more slowly than usual.
Agree Uncertain Disagree

3. Children should be buckled into safety seats every time they travel in a motor vehicle.
Strongly Agree Agree Disagree Strongly Disagree

Sample Objective #2: Dollars spent on workers' compensation will drop by at least 10% between the first and second quarters of the year.

Sample Data Collection Form

Dollars spent on workers' compensation

First Quarter $______ Second Quarter $______

Sample Objective #3: The number of employees observed following the company's highway safety policies will rise by at least 25% by the end of the first year after implementation.

Sample Form for Direct Observation

Number of employees observed wearing seat belts or helmets when entering parking lot on annual check day

Before program instituted______ After program begun______

Number of infants strapped into regulation safety seats

Last year's picnic______ This year's picnic______

Number of official designated drivers at holiday party

Last year______ This year______

 

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