Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
GENERAL INFORMATION
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Observers name
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Employee observed
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Date and time of observation
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Select Department where observation occurred
- Press
- Jogging
- Cutter
- PMC
- HandHelp
- palletizing
- warehouse
- Sheeter
- forklift use
- Plateroom
- raw material press room
OBSERVATIONS
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Describe each at risk behavior
At Risk Behavior
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Describe behavior observed
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Add media
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Describe preventative action discussed with employee
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Describe positive behaviors observed
REVIEW
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Observer name and signature
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Observer 2 name and signature
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Employee name and signature
Safety Committee Review
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Comments - Recommendations
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Review Date
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General Manager signature