Information

  • Audit Title

  • Auditors

  • Completed On

  • Location
  • Click here to add employee found to be non-compliant.

  • Employee

General Information

  • Time

  • Department

  • Job Position

  • Employee

  • Direct Supervisor

  • Department Manager

Re-Occurrence Details

  • Is this non-compliance a re-occurrence?

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

  • 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

  • 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.

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

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

  • 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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.