BOILERMAKER APPRENTICE EVALUATION REPORT- To be completed by apprentice

Date

Registration #

Your Local Lodge #

First Name

Last Name

Employer Name

Stewards Name

Job Location

# of Hours Worked

Employment Date From

Employment Date To

Type of Project Type of Project Construction Maintenance Demolition Shop

Type of Work Type of Work Bins & Hoppers Boilers Cement Plant Condensers / Evaporators Digesters Gas Plant Heat Exchangers Nuclear Power Plant Penstock Precipitator Pressure Vessel Refinery Scroll Casing Scrubbers Stacks and Breeching Tanks

Duties Duties Burning Blueprint Reading Confined Space Watch Fiberglass Fitting Grinding Layout Metalizing Rigging Tack Welding Tube Expanding

Appraisal of Job Appraisal of Job 1 2 3 4 5

Relationship with crew Relationship with crew 1 2 3 4 5

Your Supervisor Your Supervisor 1 2 3 4 5

The Journeyperson(s) The Journeyperson(s) 1 2 3 4 5

Where you ever late? Where you ever late? Yes No Often Rarely Never

Where you ever absent? Where you ever absent? Yes No Often Rarely Never

Comments:

Name

Phone

Email A copy of this completed form will be emailed to you for your records.

Signature By filling out your name, you agree your electronic signature is the legal equivalent of your manual signature.

Date Signed