Louisiana Safety Systems, Inc.

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Service Form

Field Service Job Evaluation

This form is part of our continuous improvement process at LSS. It is an assessment tool to effectively analyze areas for improvement and build upon our strengths. We greatly appreciate your assistance in helping up to provide the best possible service to our customers and the oilfield valve industry.

Client Company

Location

Date

Job Number

Type of Job

LSS Employee(s)

Ratings:

Poor
Acceptable Excellent

1 2 - 3 - 4 5

Punctuality - arrival at location, dock or heliport as scheduled:

  1
  2
  3
  4
  5

Overall preparedness for job:

  1
  2
  3
  4
  5

Tools and equipment - condition, suitability for job:

  1
  2
  3
  4
  5

Level of professional expertise and knowledge:

  1
  2
  3
  4
  5

Attitude and approach to job:

  1
  2
  3
  4
  5

Efficiency and quality of work performed:

  1
  2
  3
  4
  5

Communication with client / site personnel:

  1
  2
  3
  4
  5

Accurate / effective reporting of job progress and results:

  1
  2
  3
  4
  5

Safe work practices and proper PPE:

  1
  2
  3
  4
  5

Observance of good environmental practices:

  1
  2
  3
  4
  5

Participation in client / site safety and environmental programs:

  1
  2
  3
  4
  5

Coordination / cooperation / support of LSS office and shop personnel:

  1
  2
  3
  4
  5

Comments

Customer Representative Name

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