Calamba RDAC VIP Feedback

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General First Impressions

• The hotel we booked you in was adequate for your needs

  Yes

  No

  N/A

• The car brining you to the facility was clean and in good repair

  Yes

  No

  N/A

• Entry into the facility reflected well on the Xylem Brand

  Yes

  No

  N/A

• Restrooms were clean and well stocked

  Yes

  No

  N/A

• The Conference / Training Room was orderly and clean

  Yes

  No

  N/A

• The visit / meeting began with a safety tip

  Yes

  No

  N/A

• Meetings started on-time

  Yes

  No

  N/A

Start of the Plant Tour

• You were provided a safety briefing before entry

  Yes

  No

  N/A

• You were provided Personal Protective Equipment that was clean and in good condition

  Yes

  No

  N/A

• The Yellow striped Pedestrian Walkways were kept clear

  Safe

  At Risk

  N/A

Machining Cell

• You were greeted by the team leader who explained the cell operation and any potential hazards

  Yes

  No

  N/A

• Work areas appeared well organized

  Yes

  No

  N/A

• Area was free of any potential trip, slip hazards

  Safe

  At Risk

  N/A

• There were no obvious sharp edges that need to be addressed

  Safe

  At Risk

  N/A

• Observed Body Position & Lifting Postures Seem Safe

  Safe

  At Risk

  N/A

• Visual Management boards appear to be updated and easy to understand

  Yes

  No

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

GS Cell

• You were greeted by the team leader who explained the cell operation and any potential hazards.

  Yes

  No

  N/A

• Work areas appeared well organized

  Yes

  No

  N/A

• Area was free of any potential trip, slip hazards

  Safe

  At Risk

  N/A

• There were no obvious sharp edges that need to be addressed

  Safe

  At Risk

  N/A

• Observed Body Position & Lifting Postures Seem Safe

  Safe

  At Risk

  N/A

• Visual Management boards appear to be updated and easy to understand

  Yes

  No

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

Jets Cell

• You were greeted by the team leader who explained the cell operation and any potential hazards.

  Yes

  No

  N/A

• Work areas appeared well organized

  Yes

  No

  N/A

• Area was free of any potential trip, slip hazards

  Safe

  At Risk

  N/A

• There were no obvious sharp edges that need to be addressed

  Safe

  At Risk

  N/A

• Observed Body Position & Lifting Postures Seem Safe

  Safe

  At Risk

  N/A

• Visual Management boards appear to be updated and easy to understand

  Yes

  No

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

eSV Cell

• You were greeted by the team leader who explained the cell operation and any potential hazards.

  Yes

  No

  N/A

• Work areas appeared well organized

  Yes

  No

  N/A

• Area was free of any potential trip, slip hazards

  Safe

  At Risk

  N/A

• There were no obvious sharp edges that need to be addressed

  Safe

  At Risk

  N/A

• Observed Body Position & Lifting Postures Seem Safe

  Safe

  At Risk

  N/A

• Visual Management boards appear to be updated and easy to understand

  Yes

  No

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

Warehouse

• You were greeted by the Warehouse Supervisor who explained the operations and any potential hazards.

  Yes

  No

  N/A

• You provided with reflective stripping for enhanced visibility

  Yes

  No

  N/A

• The aisles and walkways free from clutter

  Safe

  At Risk

  N/A

• The warehouse personnel all wore the indicated Personal Protective Equipment

  Safe

  At Risk

  N/A

• Racking aisles were closed off to prevent pedestrian access

  Safe

  At Risk

  N/A

• Did you see a pedestrian in the same row as a working forklift?

  Safe

  At Risk

  N/A

• The fork trucks were being used in a safe and cautious manner

  Safe

  At Risk

  N/A

• Did you see any racking or storage practices that should cause concern?

  Safe

  At Risk

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

Machine Shop

• You were greeted by the team leader who explained the cell operation and any potential hazards.

  Yes

  No

  N/A

• Work areas appeared well organized

  Yes

  No

  N/A

• Area was free of any potential trip, slip hazards

  Safe

  At Risk

  N/A

• There were no obvious sharp edges that need to be addressed

  Safe

  At Risk

  N/A

• The equipment appeared to be well guarded

  Safe

  At Risk

  N/A

• Please snap a picture of anything that you would like to highlight

  Media

• General Comments / Suggestions

Safe behaviors observed

Potentially unsafe behaviors observed

Line of fire. Please highlight any areas found where the employee could be in the "line of fire"

Overall comments

Please list three areas where we could improve.

• Suggestions:

• Select date

  Date

• Auditor signature

  Sign