Georgiou Field Leadership Visit Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Positive Behavior/Conditions Observed

• 1

• Add media

  Media

• 2

• Add media

  Media

• 3

• Add media

  Media

At Risk Behaviors/Conditions Observed

• 1

  Safe

  At Risk

  N/A

• Consequence

  Low

  Moderate

  High

  Extreme

• 2

  Safe

  At Risk

  N/A

• Consequence

  Low

  Moderate

  High

  Extreme

• 3

  Safe

  At Risk

  N/A

• Consequence

  Low

  Moderate

  High

  Extreme

• 4

  Safe

  At Risk

  N/A

• Consequence

  Low

  Moderate

  High

  Extreme

• 5

  Safe

  At Risk

  N/A

• Consequence

  Low

  Moderate

  High

  Extreme

• Note: Issues regarding procedures to be recorded as a non-conformity

General Comments

• General Comments

Action Items

• What Action is Required?/Who/When

• What Action is Required?/Who/When

• What Action is Required?/Who/When