Information
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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
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Personnel
Employee's Name and Department
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Date/Time of Observation
Occupation and Time at Present Job
Task Observed
Type of Observation
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Initial
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Follow up
Reason for Observation
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Critical Task
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New Worker
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Incident Repeater
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Good Performer
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Poor Performer
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Other
Task Description
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Major steps required to complete task, describe:
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Is PPE required? List what is required.
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Is lock out required?
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Are all Golden Rules being followed?
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Are there any special instructions from the supervisor for the employee for completing the task at hand?
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Is the "We Care" card filled out properly?
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General Questions
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Could any of these practices/conditions observed result in property damage, personal injury or illness? Describe
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We're the methods and practices the most efficient and productive? If "NO" describe.
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Did the practice observed comply with all of the applicable procedures or standards that exist for the task? If "NO" describe.
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Did you observe any practices or aspects of the task that were improvements which deserve recognition? If "YES" describe.
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Describe clearly below practices deserving compliment/correction:
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Have you complimented or reconstructed the worker on these observations?
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Should a follow up observation of this worker be made on the near future? If "YES" why?
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Describe any standard procedure, method or equipment you observed that management should consider changing in the interest of safety or productivity:
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Follow up actions required:
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Observer
