Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
Cell Risk Assessment
CRA Summary Sheet
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Sheet must have exact same number of employees in signature area
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Look for “borrowed” employees that might be in the area and therefore signature must be present as well
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Enlisted unsafe acts and/or conditions, as well as * symbol in date that was found
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Findings as a result of Gemba with supervisor are written down in sheet
Machine Review
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Machines are to have their own LTT procedure published <br>
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TPM must be current (either week, shift, etc) and be filled in each space. Review if enlisted items are based on actual needs or if there’d be obsolete points. Enlist TPMs that were revised on floor
Escalations and Coaching
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Does the leader need to escalate any unresolved HSE issues?
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Ask leader, supervisor or employee how they perform certain tasks that might not be documented or require of fine tuning in their procedure. Explain applicable standards, talk about past incidents.
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Ask leader, supervisor or employee how they perform certain tasks that might not be documented or require of fine tuning in their procedure. Explain applicable standards, talk about past incidents.
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Ask leader, supervisor or employee how they perform certain tasks that might not be documented or require of fine tuning in their procedure. Explain applicable standards, talk about past incidents.
Miscellaneous
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Type any follow up items here
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Add any pictures here to be included in the report. You can add multiple pictures
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Add any pictures here to be included in the report. You can add multiple pictures
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Add any pictures here to be included in the report. You can add multiple pictures
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Add any pictures here to be included in the report. You can add multiple pictures
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Add any pictures here to be included in the report. You can add multiple pictures
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Add any pictures here to be included in the report. You can add multiple pictures
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Add signature
