• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Employee's Name and Department

  • Date/Time of Observation

Occupation and Time at Present Job

Task Observed

Type of Observation

  • Initial

  • Follow up

Reason for Observation

  • Critical Task

  • New Worker

  • Incident Repeater

  • Good Performer

  • Poor Performer

  • Other

Task Description

  • Add media

Major steps required to complete task, describe:

  • Add media

  • Is PPE required? List what is required.

  • Add media

  • Is lock out required?

  • Add media

  • Are all Golden Rules being followed?

  • Add media

  • Are there any special instructions from the supervisor for the employee for completing the task at hand?

  • Add media

  • Is the "We Care" card filled out properly?

  • Add media

General Questions

  • Could any of these practices/conditions observed result in property damage, personal injury or illness? Describe

  • Add media

  • We're the methods and practices the most efficient and productive? If "NO" describe.

  • Add media

  • Did the practice observed comply with all of the applicable procedures or standards that exist for the task? If "NO" describe.

  • Add media

  • Did you observe any practices or aspects of the task that were improvements which deserve recognition? If "YES" describe.

  • Add media

  • Describe clearly below practices deserving compliment/correction:

  • Add media

  • Have you complimented or reconstructed the worker on these observations?

  • Add media

  • Should a follow up observation of this worker be made on the near future? If "YES" why?

  • Add media

  • Describe any standard procedure, method or equipment you observed that management should consider changing in the interest of safety or productivity:

  • Add media

  • Follow up actions required:

  • Add media

  • Observer

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.