Title Page

Field Ranking System Audit Form

  • District - Manager/Supervisor Name:

  • Month & Year Audited:

  • Conducted on

  • Conducted by

  • Location

Employee Behavioural Observation

  • How many behavioural observation reports were required?

  • How many behavioural observation reports were entered?

  • Score of Ratio Required / Completed?

  • Does it support the score entered?

Training Verification

  • Training topic(s) for month per playbook?

  • Number of employees were required to complete training?

  • Number of employees completed training and passed quiz?

  • Score of Ratio Required / Completed?

  • Does it support the score entered?

HSE procedure / HSE Short

  • Topic of HSE procedure of HSE short same as in playbook?

  • Number of employees required to review procedure / safety short?

  • Number of employees who completed procedure / short review?

  • Score of Ratio Required / Completed?

  • Does it support score entered?

Vehicle / Tool / PPE Inspection

  • Number of Vehicle / Tool / PPE Inspections Required?

  • Number of Vehicle / Tool / PPE Inspections Completed?

  • Ratio of number required / number completed?

  • Does the ratio support the data entered?

HSE Monthly Meeting

  • Number of meetings required?

  • Number of meetings held?

  • Ratio of required / completed?

  • Does the ratio support the data entered?

Contractor Performance Evaluations

  • Number of Contractor Performance Evaluations Required?

  • Number of Contractor Performance Evaluations Completed?

  • Ratio of number required / number completed?

  • Ratio supports data entered?

Supervisor HSE Meeting

  • Supervisor used the HSE monthly template and covered all the (applicable) agenda items?

  • Supervisor effectively engaged the team, demonstrated positive HSE behaviours and expectations?

  • Employees were attentive and engaged with the supervisor and demonstrated positive HSE behaviours?

Ranking System Score

  • Ranking System Score Entered?

  • Verification Score?

  • Variation between Ranking System Score / Verification Score = %

  • Verification supports Ranking System Score Entered?

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