JMC PPE Non-Compliance Audit - Local

• Audit Title

• Auditors

• Completed On

  Date
• Location
  Address

General Information

• Time

  Date

• Department

• Job Position

• Employee

• Direct Supervisor

• Department Manager

Re-Occurrence Details

• Is this non-compliance a repeat occurrence for the employee? Please provide details in the comments section.

  Yes

  No

  N/A

• Is this non-compliance a repeat occurrence in the department? Please provide details in the comments section.

  Yes

  No

  N/A

• Is this non-compliance a repeat occurrence for the direct supervisor? Please provide details in the comments section.

  Yes

  No

  N/A

• Provide addition details and comments pertaining to the matter's re-occurrence. (I.E. has the employee, supervisor, department manager or plant manager been made aware of previous non-compliance? Were previous corrective measures required to be taken such as discipline, discussion, etc.)

Non-Compliance Details

• Specify the required PPE/Hands Off tool not being used by the employee (include PPE that is being used or worn incorrectly)?

• Specify the body parts that are unprotected as a result of the non-compliance

• Select the action(s) that was taken at the time of the initial observation of non-compliance.

  Direct operator to comply

  Observe and Document

  Initiate fact gathering discussion

• Is the employee's direct supervisor aware of the non-compliance. The auditor is required to provide sufficient details substantiating the response to this question.

  Yes

  No

  N/A

• Is the department manager aware of the non-compliance. The auditor is required to provide sufficient details substantiating the response to this question.

  Yes

  No

  N/A

• Reasons for non-compliance according to employee (if discussion was initiated)

Conclusion

• Auditors determination as to why this particular non-compliance has occurred.

• Recommendations to ensure future compliance

• Additional Comments