BOILERMAKER NATIONAL TRAVEL CARD EVALUATION REPORT (To be completed by the Lodge 359 Member) Employer's Name Name of Travel Card Member Job Location Start Date Completion Date # of Hours Worked Registration Number Job Steward's Name Type of Project Type of Project Construction Maintenance Demolition 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 Confined Space Watch Grinding Gouging Plasma Arc Cutting Pulse Arc Welding Stick Welding Tack Welding Tig Welding Other Welding Process: EVALUATION Attitude to Safety Attitude to Safety Excellent Above Average Average Below Average Unsatisfactory Attitude to Job Attitude to Job Excellent Above Average Average Below Average Unsatisfactory Attitude to Co-workers Attitude to Co-workers Excellent Above Average Average Below Average Unsatisfactory Initiative Initiative Excellent Above Average Average Below Average Unsatisfactory Capability Capability Excellent Above Average Average Below Average Unsatisfactory ATTENDANCE Absent Absent Never Often Rarely Late Late Never Often Rarely # of times absent # of times late Review & Comments: Date Name By filling out your name, you agree your electronic signature is the legal equivalent of your manual signature. Email A copy of this completed form will be emailed to you for your records. 14 + 4 = Submit