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
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Employee Name and Payroll #:
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What Department and Complex where task is being completed?
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Employee's Current Occupation and how long he/she has been at the present job:
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TASK OBSERVED:
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Select date
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Type of Observation:
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Reason for Observation:
- Critical Task
- New Worker
- Incident Repeater
- Good Performer
- Poor Performer
- Other
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Task Description:
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Major steps required to complete task (eg. PPE, Lockout, Non-Routine, etc.)
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Could any of these practices/conditions observed result in property damage, personal injury or illness? If "Yes", describe.
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Were 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 this 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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Clearly describe any practices that deserve Compliment or Correction:
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Have you complimented or reinstructed the worker on these observations?
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Should a follow-up observation of the worker/task be made in the near future? If "Yes" describe why.
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Describe any standard procedure, method or equipment that you observed and feel that management should consider changing in the interest of safety or productivity.
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Follow-up action(s):
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Observer:
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Supervisor:
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Department Head:
