STRUCTURAL WORK REPORT
TO ACCOMPANY APPLICATION FOR MEMBERSHIP – PLEASE INCLUDE AS MUCH INFORMATION AS POSSIBLE
FROM DATE:______TO DATE:______
NAME OF CONTRACTOR : ______
NEW APPLICANT OR TRANSFER
APPRENTICE OR JOURNEYMAN
IRONWORKER WELDER
NAME OF APPLICANT:
SIN #
PERMANENT ADDRESS:_
CITY: ______PROV______PC ______
PHONE # CELL #
YEARS OF EXPERIENCE IN TRADE ______
This form is NOT to be shown to the applicant once completed, sign it and turn it over to the Job Steward so he/ she may forward it to the Union Hall. This form is to be completed by the Foreman along with the 2 Journeyman Members who worked with the applicant.
WHAT CERTIFICATIONS DOES APPLICANT HAVE:
□ CSTS
□ EWP
□ FALL ARREST
□ H2S
□ CONFINED SPACE
□ FIRST AID
□ CWB □ RED SEAL
□ FLUX CORE / WIRE
□ B PRESSURE
What Form of Construction/Maintenance was the Applicant Involved in?
□ Oil sands
□ Petro chemical
□ Power Generation
□ Bridge
□ Modules
□ Beam & Joist
□ Blue prints
□ Towers
□ Pre-Engineered
Type of Work Performed:
□ Connecting
□ Fall Arrest Systems
□ Installation
□ Lay-out Fitting
□ Grating
□ Jacking
□ Bolting & Impacting
□ Tack Welding
□ Mechanical Rigging
□ Hooking On
□ Rigging
□ Unloading
□ Mechanical Assembling
□ Cutting
Type of Equipment:
□ Crane
□ Crawler
□ Hydraulic
□ Mobile
□ Heavy Lift
□ Tugger
□ BoomTruck
□ Over Head Crane
□ EWP
□ Zoom Boom
□ Fork Lift
What tools did the applicant work with? (Check off all that apply)
Hand Tools / Air/Power Tools / Measuring & Layout / Safety Equipment□ Beam clamps / □ Chop saw / □ Tape / □ Cables
□ Cable cutters / □ Compressor / □ Piano wire / □ Stanchions
□ Reamers / □ Cut off saw / □ Squares / □ Life lines
□ Hammers / □ Deck saw / □ Levels / □ Scaffold
□ Wrenches / □ Grinder
□ Mag drill / □ Impact gun
Rigging Equipment / PPE / Scaffolding / access equip / Welding/Cutting Tools
□ Shackles / □ Fall arrests / □ Aerial work / □ Oxy/Acetylene outfit
□ Blocks / □ Body harness / □ Angel wing / □ Tiger Torch
□ Chain Falls / □ Retractables / □ Radiograph
□ Speader Beam/Bar / □ Swingstages / □ Arc Welding Machine
□ Wire Rope Slings / □ Wire-rope
□ Cable Clamps / □ Welding – wire
□ Come Alongs / □ Welding – stick
□ Turnbuckles
□ Nylon Slings
FOREMAN EVALUATION
Please provide as much information as possible
NAME: ______HOME LOCAL: ______
After proper instructions was the work performed of good quality?
Yes___ No ____
Were there any problems with failure to use the equipment listed above, or failure to comply with safety rules? ______
Did the applicant work in the air? Yes ______No ______
What attitude did the applicant show toward safety?
□ Poor / □ Average / □ ExcellentWas the applicant ever involved in an accident or injury? Yes___ No ___
If yes, explain? ______This should include all examples of first aid, modified work… this will give the Examining Committee an idea of how careful, or how injury prone the applicant is.
Specifically, during the time this report covers, how many times was the applicant late? How many times absent without excuses? Include the excuses. ______
Does the applicant have a good attitude toward his/her fellow workers?______
Would you want this person for your crew or as a partner again? Yes ____ No_____
If no, why not? ______
Signature ______
JOURNEYMAN EVALUATION
Please provide as much information as possible
NAME: ______HOME LOCAL: ______
After proper instructions was the work performed of good quality?
Yes___ No ____
Were there any problems with failure to use safety equipment, or failure to comply with safety rules? ______
Does the applicant approach work in a cheerful manner or is there a reluctance to perform all or any tasks? ______
In your opinion did the applicant perform as much work as he/she was capable of doing? Yes _____ No _____
If no, why not? ______
Does the applicant have a good attitude toward his/her fellow workers and toward his/her supervisor? ______
Would you want this person for your crew or as a partner again? Yes ____ No_____
If no, why not? ______
Signature ______
JOURNEYMAN EVALUATION
Please provide as much information as possible
NAME: ______HOME LOCAL: ______
After proper instructions was the work performed of good quality?
Yes___ No ____
Were there any problems with failure to use safety equipment, or failure to comply with safety rules? ______
Was there any difficulty getting the applicant to understand or to comply with directions in an expedient manner without grumbling? ______
In your opinion did the applicant perform as much work as he/she was capable of doing? Yes _____ No _____
If not, why not? ______
What is the personal appearance of the applicant in regards to neatness and cleanliness? ______
Is the applicant in good physical condition for work in our trade?
Yes ____ No ____ If no, what area’s need improving? ______
Would you want the applicant for your crew or as a partner again? Yes ____ No_____
If no, why not? ______
Signature ______
JOB STEWARD EVALUATION
Please provide as much information as possible
NAME: ______HOME LOCAL: ______
Has the applicant had any verbal/written disciplinary action? ______
Were there any complaints from the members/workers the applicant has worked with? ______
Has the applicant been involved in all aspects of the trade? If an apprentice, has the applicant been rotated through all the different crews? ______
Was there any difficulty getting the applicant to understand or to comply with directions in an expedient manner without grumbling? ______
In your opinion did the applicant perform as much work as he/she was capable of doing? Yes _____ No _____
If not, why not? ______
What is the personal appearance of the applicant in regards to neatness and cleanliness? ______
Is the applicant in good physical condition for work in our trade? Yes ____ No ____ If no, what areas need improving? ______
Signature ______
GENERAL COMMENTS:
YOUR FEEDBACK IS GREATLY APPRECIATED!
The Examining Committee relies on these reports. Often there is not enough feedback, so any additional information would help in the evaluation. ______