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Safety Engineer Development Plan Guide

US Department of Transportation

Federal Highway Administration

February 2001


Table of Contents


Introduction

Development Plan

Plan Guidelines
Timing of Plans

Training

Professional Development Academy
Technical Training

Safety Engineer Competency Framework

Program Competencies
Technical Competencies
Professional Competencies

Materials For Safety Engineer Participants

Useful Websites

Sample Development Plan


 

Introduction


This document supplements the Professional Development Program (PDP) Handbook and will guide the sponsoring office in designing a comprehensive Development Plan (DP) for Safety Engineer participants for the Federal Highway Administration's (FHWA) PDP.  Detailed information on the responsibilities of the sponsoring office and coaches as well as evaluation and general guidelines, can be found in the PDP Handbook.

The participant will be teamed with a senior safety engineer in a Federal Aid Division Office who will serve as the mentor.  The mentor, in cooperation with the PDP Manager, will work with the participant to build the Development Plan to ensure that at the end of the program, the participant will have acquired the core competencies outlined in this Safety Engineer Development Plan Guide.  After the mentor has determined the participant's core competency needs, assignments will be scheduled to address these needs.  Other factors that will be considered are geographical diversity and the participant's permanent assignment.  In addition to assignments in the sponsoring office, the participant could  have assignments in FHWA Headquarters, other FHWA Division Offices or Resource Centers, a  state highway agency or another appropriate location, in addition to Professional Development Academy activities.  While on assignments outside of the sponsoring office, the participant will be teamed with secondary mentors who will communicate regularly with the mentor to ensure that the competencies to be worked on during each assignment are being adequately addressed.

The objective of the Professional Development Program is to ensure the participant achieves the core competencies of his/her discipline.  This Guide addresses the competencies necessary for a Safety Engineer to perform in a Federal Aid Division Office.


Development Plan


A Development Plan (DP) will be established by the sponsoring office for each participant within the first month of the program.  The purpose of the DP will be to meet the competencies for graduates in their discipline.  The participant's education, experience, strengths, and weaknesses will be analyzed and a series of Developmental Assignments, Professional Development Academy and technical training opportunities will be designed to supplement the apprentice experience being gained in the sponsoring office.  The DP will serve as an agreement between the sponsoring office, the participant and the PDP Manager, to ensure development of the participant to meet the core competencies of the discipline.  It will be a working document and may be modified as needed.  A copy will be provided to the participant and the PDP Manager.

A Sample Development Plan is provided showing what a typical plan looks like (Exhibit A).  The individual plan the sponsoring office creates will contain more specific development opportunities.

Guidelines

The sponsoring office should use the following guidelines to complete a DP for Safety Engineer participants:

  1. Interview the participant to determine what competencies already exist and the needs and interests of the individual.  It is anticipated the participant will be spending the first few months of the training program in the sponsoring office.  This will allow time for the coach to get to know the participant and establish an effective DP based upon the abilities and needs of the participant.
  2. Review the Safety Engineer Development Plan Guide with the participant and outline a draft DP that will ensure the participant acquires the necessary competencies, including developmental and training opportunities.
  3. Review the DP with the participant and make necessary adjustments to assure that all required competencies will be acquired.
  4. Determine the availability of developmental training assignments through contact with the Headquarters Office PDP Management Team, and adjust the DP as necessary.  Formal approval of the DP is not required, however, a copy must be furnished to HAHR-31 in Headquarters.  It is the sponsoring office's responsibility to coordinate the DP with all parties involved and monitor progress.
  5. Begin execution of the DP, and adjust quarterly as necessary during the two-year PDP.

Timing of Plans

The following demonstrates the general amount of time the participant will spend in each portion of the program.  Because the developmental assignments can range in length, they are not specified here individually, but are expected to be spread throughout the program.  

Sponsoring Office:  Federal-Aid Division Office

  1. On-the-Job-Training (OJT) in sponsoring office (total of 12 months)
    Various projects to ensure exposure to variety of safety activities
  2. Developmental assignments with State Highway Agency (SHA), Resource Center (RC), Headquarters (HQ) another Division Office (DO), etc.  (total of 10 months)
  3. Professional Development Academy (total of 2 months)
    Check with Headquarters PDP Team for schedule

Training


There are National Highway Institute (NHI) courses available to supplement the development of new participants and contribute to competency development.  The NHI course catalog is available in the Division Office and on the Internet at nhi.fhwa.dot.gov and should be utilized to determine which courses best suit the needs of the participant.  In addition, the sponsoring office is encouraged to incorporate training from local sources, particularly training offered by state and local governments,  into the participant's development plan.  Membership in the Institute of Transportation Engineers is considered an important aspect of safety engineer's professional development.

Professional Development Academy

The following information is a very minimal explanation of what the Academy will provide.   Detailed information can be found in the PDP Handbook located on StaffNet (Education & Training: FHWA Professional Development Program: PDP Handbook: Appendix C), or  http://intra.fhwa.dot.gov/opt/training/FHWAPDP/apendixC.htm

The Academy is intended to be comprised of 4 components for a total of 6 weeks over the course of the PDP.  These orientation and training sessions are mandatory for all PDP disciplines. 

Components

Duration

Time line & Location

I.     Human Resource Orientation

2-4 Hours

Within first 4 weeks of PDP
(via teleconference)

II.    Orientation to Federal Employment and Introduction to FHWA

2 Weeks

Within first 6 months of PDP
(conducted in Washington DC)

III.  Interpersonal and Leadership Skills

4 Weeks
(Two 2-week sessions)

Over the course of the 2-year PDP (usually in Washington DC)

IV.  Basic Technical /Semitechnical Training

4 core training courses, totaling 1 ½ Weeks

Throughout PDP
(various locations)

 

Component IV the Professional Development Academy will include:  1) Financing Federal Aid Highways; 2) Intelligent Transportation Systems (ITS) Awareness;  3) Introduction to National Environmental Policy Act (NEPA); and 4) Contract Administration.  The Headquarters Office PDP Management Team will be responsible for scheduling these sessions through coordination with the sponsoring office.  The participant's DP should include opportunities to enhance/reinforce the skills taught during the Academy sessions.


Technical Training

Many training opportunities are available and are listed in the developmental opportunities of  the program framework that follows.  It is not anticipated that all participants will want or need all the possible training activities.  There are, however, some priorities for most participants in terms of recommended formal training.  Those courses considered most important are listed below as "core courses"  the second list contains highly recommended training, depending on the interest and experience of the participant.  Other courses mentioned elsewhere in this Guide are considered highly area specific, and are advised if the participant has a very strong interest in those areas.  When an NHI course is not available, supplemental sources, including state and local governments, LTAP centers and Universities should be considered. 

Core Courses

Highly Recommended Training(may be obtained through participation at FHWA workshops, various conference sessions, university short courses, state and industry sponsored seminars and conferences or FHWA training courses, if developed)


Safety Engineer Competency Framework


The PDP Safety Engineer Competency Framework outlines the competencies that the participants should acquire during the course of their PDP.  The selection of assignments for the participant should be tailored to ensure that he/she gets the opportunity to achieve the maximum amount of these competencies.  It is not expected that all development opportunities listed will be utilized.  A reasonable mix of opportunities should be utilized to achieve the desired competencies.

Safety Specialist - Professional Development Program

Program Competencies

        Development Opportunities

FHWA Mission, Organization, and Roles (Agency Structure, Relationships, and Partnerships)

Demonstrates knowledge of FHWA Mission and organizational structure and how FHWA fits within the United States Department of Transportation (USDOT) and the Federal Government, and the concept of interagency coordination.

Performs within the relationships and partnerships involved in administering the Federal-Aid Highway program (i.e., other Federal Agencies, State/Local Agencies, Federal Lands, Tribes, Other Public/Private Organizations, and General Public), in particular the unique Federal-State relationship.

Builds and maintains relationships with internal and external partners, especially the National Highway Traffic Safety Administration (NHTSA) and the Federal Motor Carrier Safety Administration (FMCSA) through various phases of project activities.  Accommodates customer needs through application of sound engineering knowledge and judgement.

Understands  the roles and responsibilities of the different business units and their interaction within FHWA including: Headquarters Core Business Units, Support Business Units, Resource Centers, Division Offices, Turner-Fairbanks Research Center, and Federal Lands Highway Divisions, and utilizes the resources available in each of those offices.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy
  • Attend intermodal meeting(s)

Strategic Planning and Corporate Culture

Understands the strategic planning process and performance measures and how they relate to highway safety work activities.  Familiar with the National Strategic Plan, the National Performance Plan, and Core Business Unit Work Plans, particularly the Safety Core Business Unit.

Demonstrates awareness of FHWA core values and the Quality Cornerstones and how they relate to the delivery of the Federal-Aid program.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy
  • Participate in the development of the sponsoring office Annual Work Plan

Program Awareness and Program/Project Management

Aware of the various programs administered within the FHWA (e.g., Planning, Bridges, Civil Rights, Environment, Right of Way, Local Technical Assistance Program (LTAP), Financial, Federal Aid).

Explains the difference between laws, regulations, policy, etc., the order of precedence, the relationship of one to the other, and in general the process by which each is developed.  Has general knowledge regarding the application of each to transportation programs and projects.

Understands roadway functional classification and designated Federal-Aid systems.  Is familiar with various categories of Federal-Aid financing, especially safety program funding, and associated eligible costs.

Has awareness of environmental, pavement materials, right of way, structures, operations and research programs as well as the safety program in a DO and project development in a SHA.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy

Stewardship

Understands and applies the methods and practices used in oversight of the Federal-Aid program, including the use of Stewardship Plans and Partnership Agreements.  Understands and has the ability to actively participate in monitoring techniques such as process reviews, product evaluations, in-depth inspections, continuous process improvement studies, etc.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy
  • NHI and local training courses

Safety Specialist - Professional Development Program

Technical Competencies

       Developmental Opportunities

Geometric Roadway Design

Demonstrates a working knowledge of the relationship of roadway design elements and safety.  This includes a knowledge of the AASHTO Policy on Geometric Design of Highways and Streets and AASHTO Highway Safety Design and Operations Guide. 

Demonstrates an understanding of the relationship of safety, environment and capacity in the planning and design process (Context sensitive design).  This includes the design exception process.

  • Sponsoring office assignments (OJT)
  • Developmental assignment (SHA, RC)
  • Participate in a plan-in-hand or other field review such as a road safety audit
  • Review and comment on Plans, Specifications and Estimates (PS&E)
  • Review and comment on a request for  design exception approval
  • Review and comment on an interstate access approval
  • Attend formal training:
    • Basic geometric design
    • Context sensitive design
    • Human factors
    • Older driver

Highway Safety Improvement Program (HSIP)

Demonstrates a working knowledge of regulatory requirements and best practices relating to the planning, implementation, and evaluation components of Federal-Aid and highway safety improvements projects, including those for the hazard elimination program and the railroad-highway grade crossing program.  This will require an understanding of traffic records, crash data analysis, problem identification and countermeasure selection.

  • Sponsoring office assignment (OJT)
  • Developmental assignment (SHA, Department of Public Safety, Metropolitan Planning Office (MPO), Highway Safety Office)
  • Participate in field reviews with state counterparts
  • Review SHA's HSIP processes
  • Review state's before and after report on specific HSIP project
  • Evaluate the effectiveness of a specific HSIP project
  • Attend formal training:
    "Identification and Treatment of High Hazard Locations" (Northwestern University or equivalent)

Manual on Uniform Traffic Control Devices (MUTCD)

Demonstrates a working knowledge of the MUTCD including: part 1, part 2 (general standards, application, classification and design of regulatory, warning and guide signs), part 3 (pavement marking general principles), part 4 (warrants) and part 8 (general). 

Demonstrates a general understanding of the remainder of the MUTCD.  Also demonstrates an understanding of the MUTCD as it relates to older driver highway design recommendations and retroreflectivity

  • Sponsoring office assignment (OJT)
  • Developmental assignment (SHA traffic unit)
  • Review PS&E for application of MUTCD standards and guidance
  • Prepare and give a presentation on the  MUTCD 2000
  • Attend formal training:
    • Older drivers
    • MUTCD 2000

Pedestrians and Bicyclists

Demonstrates a working knowledge of application, policies, requirements and good engineering practices, including traffic control devices and human factors, to ensure the safe accommodation of pedestrians and bicyclists.  This knowledge should include consideration of special user groups including older road users and disabled road users.  Demonstrates an understanding of the pedestrian and bicycle resource kits.

  • Sponsoring office assignment (OJT)
  • Developmental assignment (SHA or large city MPO ped/bike office)
  • Review and comment on a PS&E for ped/bike accommodation
  • Participate in a plan-in-hand review or road safety audit in an urban environment
  • Attend Community Traffic Safety Program Meeting
  • Review criteria for transportation enhancement program for safety appropriateness
  • Participate in Pedestrian Roadshow
  • Attend applicable formal training

Roadside Safety

Demonstrates a working knowledge of the engineering principles, functions, and applications of Roadside Safety appurtenances. 

Demonstrates an understanding of roadside safety policies, crash testing procedures and device performance, including NCHRP 350.

  • Sponsoring office assignment (OJT)
  • Developmental assignment (DO, SHA, Crash Testing Research Facility, RC)
  • Attend American Traffic Safety Systems Association (ATSSA) meeting
  • Participate in meetings with suppliers, vendors and manufacturers of roadside hardware
  • Attend formal training:
    • NHI Course 380032 "AASHTO Roadside Design Guide"
    • NHI Course 38034 "Design, Construction and Maintenance of Highway Safety Appurtenances and Features"

Safety Management

Demonstrates an understanding of Road Safety Audits (RSA), the process by which an independent examiner reports on the crash potential of an existing or future project.

Demonstrates an understanding of how safety is integrated into the transportation community.  This involves bringing together all groups promoting transportation safety.

Demonstrates an understanding of context sensitive design in the planning process that examines the trade-offs between safety and environmental concerns.

Demonstrates an understanding of the components of a comprehensive traffic records system, including crash reporting, data management, Fatal Analysis Records System (FARS) and Model Minimum Uniform Crash Criteria (MMUCC).

Demonstrates an understanding of countermeasures implemented to reduce the frequency and severity of crashes.

Demonstrates an understanding of access management that balances the need for land development with the preservation of capacity and design speed.

Demonstrates a working knowledge of the Highway Safety Plan (HSP) established in 23 USC 402.  This includes working closely with the Governor's Highway Safety Office (GHSO) and NHTSA.

  • Sponsoring office assignment (OJT)
  • Developmental assignment (DO, SHA (engineering functions in crash analysis), Governor's Highway Safety Office, MPO)
  • Review MPO's unified planning work program (UPWP)
  • Participate in state traffic records coordinating committee
  • Attend AASHTO Standing Committee on Highway Traffic Safety meeting
  • Attend Traffic Records Forum
  • Participate on a Road Safety Audit team
  • Attend State FARS review meeting
  • Attend agencies' safety planning meetings
  • Review state's highway safety plan
  • Attend National Association of Governor's Highway Safety Representatives (NAGHSR) Annual Meeting
  • Attend Lifesavers Conference    
  • Attend formal training:
    • Context sensitive design
    • NHI course 13378 "Access Management and Land Development"
    • Road Safety Audits
    • NHTSA Highway Safety Grants Management course
    • Data analysis training

Traffic Engineering

Demonstrates a working knowledge of traffic engineering principles as they relate to the development and implementation of advanced strategies and technologies to improve traffic management, highway operations, capacity and safety.  This will require an understanding of human factors, capacity analysis, traffic operations, road safety audits, traffic calming and safety applications of ITS.

  • Sponsoring office assignment (OJT)
  • Developmental assignments (SHA (traffic office or district traffic office), City, County)
  • Attend Institute of Traffic Engineers (ITE) Annual Meeting
  • Attend formal training:
    • Human factors
    • Older drivers
    • Traffic Engineering Short Course  (e.g., "Traffic and Transportation                    Engineering Seminar" at Northwest  University or equivalent)
    • Road Safety Audit
    • NHI Course 133005 "Highway Capacity and Quality of Flow" or other highway capacity short course

Work Zones

Demonstrates a working knowledge of  Part 6 of the MUTCD including: typical applications, eight fundamental principles, appropriate design and deployment of traffic control devices (TCD) and sign supports, breakaways, sight distance, height, retroreflectivity, etc. 

Demonstrates a working knowledge of roadside safety within work zones including NCHRP 350 requirements and implementation dates.

Demonstrates a working knowledge of pedestrian accommodation principles in work zones.

Demonstrates a general understanding of concepts of retroreflectivity, TCD product innovations, work zone crash causation, worker safety with respect to traffic, flagging procedures and Changeable Message Sign design, location, placement and message application.

  • Sponsoring office assignment (OJT)
  • Developmental assignment (SHA - develop a traffic control plan)
  • Participate in a variety of work zone inspections (rural, urban, day, night, federal, state)
  • Attend ATSSA meeting
  • Attend AASHTO Traffic Engineering subcommittee meeting
  • Review and comment on a work zone traffic control plan
  • Attend formal training:
    • NHI Course 380003 "Design and Operations of Work Zone Traffic Control"
    • NHI Course 380063 "Construction Zone Safety for Inspectors"
    • NHI Course 380060 "Work Zone Traffic Control for Maintenance Operations on Rural Highways"
    • ATSSA Courses on Traffic Control for  Worksite Supervisors and Flagging

Safety Specialist - Professional Development Program

Professional Competencies

Development Opportunities

Outreach

Demonstrates ability to promote FHWA safety and technology programs with SHA, MPO, LTAP and local agencies.

Demonstrates ability to work with State and local transportation agency safety personnel and other safety partners for the purpose of promoting current FHWA policies and programs, implementing guidance, and advancing emerging activities.

Assists in providing technical assistance and direction in the development of projects including general approach, application of standards, criteria, and policies.

Participates in technology sharing with partners and customers by identifying best practices, new applications, etc.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy
  • Developmental assignment (DO, RC, GHSO)
  • Participate in regional and national safety workshops

Communication

Develops effective communication skills, including the ability to negotiate effectively in controversial situations.

Demonstrates ability to communicate effectively and confidently to small and large groups.

Demonstrates ability to effectively communicate technical presentations to customers, partners and others as needed.

Applies skills in listening, writing, making effective presentations, facilitating, and marketing the agency's objectives and programs with all customers and partners.

Takes necessary actions to prepare letters, reports, studies on findings, and recommendations, and follow up on corrective action, in a professional manner.

  • Sponsoring office assignment (OJT)
  • Professional Development Academy
  • Prepare and give a short presentation on a safety issue of importance
  • Developmental assignment (DO, RC)
  • Perform routine contacts on technical issues
  • Consider presentation skills training (Toastmasters, instructor development course, etc.)
  • Consider writing skills training
  • Review samples of existing correspondence for format and presentation
  • Develop draft correspondence for project related items for review (i.e. trip report, submittals, etc.)
  • Review and synthesize complex documents and prepare a concise summary

Teamwork

Demonstrates ability to develop and sustain cooperative working relationships in all aspects of the job, to facilitate cooperation and foster commitment, team spirit, pride and trust.

Training in this professional skill competency will be obtained primarily during Component 3 of Professional Development Academy.  Additional opportunities unique to the sponsoring office should be provided to enhance this professional competency, such as:

  • Participate as a team member on a Division/State review team
  • Attend and participate in team meetings
  • Attend a leadership team meeting

Customer Service

Demonstrates ability to balance interests of a variety of clients, to anticipate and meet the needs of customers/clients, and to commit to continuous improvement of services.

Training in this professional skill competency will be obtained primarily during Component 3 of Professional Development Academy.  Additional opportunities unique to the sponsoring office should be provided to enhance this professional competency, such as:

  • Review customer survey process and feedback.
  • Review team and division performance measures.

Interpersonal Skills

Demonstrates ability to consider and respond appropriately to the needs, feelings, and capabilities of different people in different situations in a compassionate, sensitive and respectful manner.

Training in this professional skill competency will be obtained primarily during Component 3 of Professional Development Academy.  Additional opportunities unique to the sponsoring office should be provided to enhance this professional competency.

Partnering

Demonstrates ability to develop networks and build alliances, to confidently engage across boundaries, and to find common ground with a wide range of stakeholders.

Training in this professional skill competency will be obtained primarily during Component 3 of Professional Development Academy.  Additional opportunities unique to the sponsoring office should be provided to enhance this professional competency.


 

Materials for Safety Engineer Participants


A package of materials will be distributed to the Safety Engineer participant upon entering the PDP program by the Professional Development Office.  Upon reporting to work, the sponsoring office will be expected to provide specific materials for the participant, as identified in the first list below. Items in the second list are documents that should be available to the participant, but he/she will not require a separate, personal copy.

Participants should provided with a personal copy of the following materials

Participants should have access to the following materials

 

Useful Websites

FHWA Safety Core Business Unit
National Highway Institute
Manual on Uniform Traffic Control Devices
FHWA Office of Research
Federal Highway Administration
National Highway Traffic Safety Administration
National Transportation Safety Board
Context Sensitive Design
National Technical Information System
Roadway Safety Audits
National Association of Governor's Highway Safety Representatives
Roadway Safety Foundation
American Traffic Safety Services Association
Institute of Transportation Engineers
American Association of State Highway Transportation Officials
Insurance Institute for Highway Safety
International Society of Safety Data Professionals, Traffic Records
Operation Lifesaver
Transportation Research Board
NCHRP Projects
Midwest States Smart Work Zone Deployment Initiative
Texas Transportation Institute
Northwestern University Traffic Institute
Worcester Polytechnic Institute
Barrier Systems, Inc.
Energy Absorption Systems, Inc.
Trinity Industries, Inc. (highway safety products)


Sample Development Plan

(The individual plan the sponsoring office creates will contain more specific development opportunities) Exhibit A

Name:    Safety Trainee                                                                                       Program Start Date:    1/1/2001                   

Sponsoring Office:    XX Division Office                                         Coach:    Safety Guru                                                     

Career Goals:   Safety Engineer                             

Time line

Component

Activity

Competency

Accomplishments/Date Completed

1/1/200 - 5/1/2001

OJT - Sponsoring Office

Orientation and IDP
Review PS&E
Field review
Core training

Geometric Roadway Design
FHWA Organization/Roles/Mission
Strategic Planning
Session 1 of the Academy

 

5/1/2001- 5/15/2001

Academy

Professional Development Academy

Session 2 of the Academy

 

5/15/2001- 9/15/2001

Developmental Assignment: MPO

Field reviews
Project evaluation
Core training

HSIP
Program/Project Management

 

9/15/2001- 10/1/2001

Academy

Professional Development Academy

Session 3 of the Academy

 

10/1/2001- 2/1/2002

OJT - Sponsoring Office

Review UPWP
Review Highway Safety Plan

Safety Management
Partnering

 

2/1/2002 -

4/1/2002

Developmental Assignment: SHA

Review PS&E
Plan in hand
Pedestrian Roadshow

Pedestrian and Bike
Traffic Engineering

 

4/1/2002 - 4/15/2002

Academy

Professional Development Academy

Session 4 of the Academy

 

4/15/2002 - 6/15/2002

Developmental Assignment: RC

Road safety audit
Crash testing
Core training

RoadsideSafety
Outreach
Teamwork

 

6/15/2002 - 8/15/2002

Developmental Assignment: SHA

Develop traffic control plan
Work zone inspections

MUTCD
Work Zones
Communication

 

8/15/2002 - 1/1/2003

OJT - Sponsoring Office

Complete fulfillment of competency requirements

Customer Service

 

Note:  1)  The shaded areas are to be completed by the participant.
          2)  The Development Plan is to be submitted initially and then quarterly with any plan modifications and endorsements by the participant and coach.

 


Development Plan

Name:                                                                                                     Program Start Date:                                                                      

Sponsoring Office:                                                                               Coach:                                                                                     

Career Goals:                                                                                                                                                                                                   

Time line

Component

Activity

Competency

Accomplishments/Date Completed

         
         
         
         
         
         
         
         

Note:  1)  The shaded areas are to be completed by the participant.

          2)  The Development Plan is to be submitted initially and then quarterly with any plan modifications and endorsements by the participant and coach.


TOTAL TRAVEL EXPENDITURES FOR THE REPORTING PERIOD: $                                                                     Reporting Period:  Year                             Quarter

COMMENTS:

 

 

 

 

 

 

 

 

                                                                                                                                           

  PARTICIPANT SIGNATURE                                                         DATE

   I understand that my signature indicates only that I have had the opportunity to review the completed form, and my supervisor has discussed my program with me.

 

COMMENTS:

 

 

 

 

 

 

 

 

 

                                                                                                                                         

SUPERVISOR/COACH SIGNATURE                                                           DATE

 


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