gbbselection form

8/12/2019 GBBSelection Form

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Green Belt Nomination and Declaration Form

A General

A1 Name (First-Middle-Last)

A2 Gender

A3 Designation

A4 Date of Birth (dd-mm-yyyy)

A5 Department

A6 Directly reporting to

A7 Whether working in shiftsA8 Education

A9 e-mail id

A10 Mobile no.

A11 Land line contact no. (Office)

A12 Land line contact no. (Res)

B Remarks

B1 Yes No

B2 Yes No

B3 Yes No

B4 Yes No

B5 Yes NoC

C1

C2

C2.1 Yes No

C2.2 Yes No

C2.3 Yes No

C2.4 Yes No

C2.5 Yes No

C2.6 Yes No

C3

C3.1 Yes No

C3.2 Yes No

C3.3 Yes No

C3.4 Yes No

C3.5 Yes No

C3.6 Yes No

D

D1 Yes No

D2 Yes No

D3 Yes No

D4 Yes No

E

E1 Yes NoE2 Yes No

E3 Yes No

E4 Yes No

E5 Yes No

E6 Yes No

E7 Yes No

E8 Yes No

Data Entry

Data Manipulation (Sorting/ Filtering)

Quality and Problem solving Training

Any formal training on six sigma ? (Described type & duration if yes)

Any formal training on application of 7 QC tools?

Any formal training on ISO9001 QMS?

Any formal training on DOE techniques?

Preparation of organization Chart

Any formal training on pokayoke/ Mistake proofing?Computer operation and application Training

Any formal training on computer operation and application

Knowledge of MS Excel

Resources

Whether internet/ intranet facilities available in office and accessible?

Whether internet facility available at your home?

Graphs Generation

Satistical Calculation

Use of Pivot Table

Knowledge of MS Powerpoint

Slide preparation and presentation

Animation

Use of drawing tools

Cell Formating

Whether computer available in the department and accessible to you?

Whether computer available at your home?

Male/ Female

Graphs Insertion

Image/ Picture insertion

Your availability in day time at least once in a week for project guidance by QGS

Review the progress of project execution with Champion once a week

Not to allow positional and departmental barrier within team

Do you agree and give your consent to the following:

Interested to become a Six Sigma Green BeltDevote 10 hours/ week on project execution (apart from training days)

Lead and guide the project team for one year

Maintain daily project log and send weekly progress report to QGS

Your total availability in day time during training

QGS-BSL-0901-00 PAGE 1




A

A1A2

A3

A4

A5

A6

A7

A8

A9

A10

A11

B

B1 Yes No

B2 Yes No

B3 Yes No

B4 Yes No

B5 Yes No

B6 Yes No

a. Top 25% b. Top 50% c. Other

Recommendation by Champions

Shall allow him/ her to meet QGS Consultant once a week for guidance

Comfort level with computer

Capability to face challenges

Learning attitude a. Good b. Average c. Poor

Leadership and team player

Signature of Green Belt (Nominee) Date:

a. Good b. Average c. Poor

Last two year's performance (Tick correct)Open minded

Analytical capability

Approach

Agree : Disagree:

a. Excellent b. Good c. Average d. Poor

a. Positive b. Neutral c. Negative

Technical Skill

Name of the nominee

Department

Key Remarks:

Conclusion: Nomination Accepted/ Declined

LEAD MASTER BLACK BELT

Date:

Evaluation

Consent

I/ we recommend/ do not recommend Mr./ Ms……………………………………………………………………………………………………….. for

his/ her nomination and training for Six Sigma Green Belt.

Project Champion Department Head/ Nodal Champion

Date: Date:

For use by QGS Master Black Belt:





Dedication to responsibilities a. Good b. Average c. Poor

Management Skill

Shall review his/ her project progress at defined frequency

Shall provide necessary support as and when needed

Shall ensure his/ her total availability during training

Shall ensure and allow him/ her to devote 10 hours / week on project

Shall make available necessary infrastructure (Computer, internet etc…)





Nomination No.:


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