LTB.CMS.002 Audit of assessments – administration

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Adminstration

• Audit area

• Number of assessments audited

• Assessments sampled

Scope and Objectives of the Audit

• References

• Objectives

• undefined

Summary

• Samples commented

Findings

• Point examined

• Findings

• Corrective action opened

  Yes

  No

• Corrective action reference

Conclusion

• Level of finding

  Level 1

  Level 2

  Level 3

• Is TM CAD informed

  Yes

  No

  N/A

• Is safety impacted?

  Yes

  No

Audit outcome

• Findings

• Root Cause Analysis

• Corrective action Plan (CAP)

• Responsible for CAP

• Due date

  Date

Safety Assessment

• Is safety impacted?

  Yes

  No

• Ia a Safety event raised?

  Yes

  No

  N/A

• Safety Event reference?

Audit performance completion

• Has the audit been conducted on time?

  More than 15 days delay

  Within 15 days after due date

  at due date (at the latest)

• What is the Root cause analysis?

• Are more ressources required?

  Yes

  No

• Is AM informed?

  Yes

  No

  N/A

• Date

  Date

• Audit performed by:

  Sign