Page de titre
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Site de réalisation
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Employee Name and Department (completing checklist)
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Task / Area being observed
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Type of Observation
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Date and Time of observation
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Préparé par
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Position
General
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Reason for observation
- General Inspection
- Critical Task
- Incident repeat area, task or person
- Good performing area, task or person
- Poor performing area, task or person
- Other
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Specify
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Task Description
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Major / Primary steps required to complete task
Audit
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Is special PPE require?
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Is Lock-Out required?
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Is a Risk Assessment required?
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Are there any special instructions from the supervisor for the employee for completing this task?
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Is the SLAM completed correctly?
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Is the Work Permit and DSTI completed correctly?
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Could any of the observed practices / conditions result in property damage, personal injury or illness?
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If yes, describe
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Where the methods and practices observed the most efficient and productive?
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If No, describe
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Did the practices observed comply with all of the applicable procedures or standards that exist for the task?
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If No, describe
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Did you observe any practices or aspects of the task that where improvements which deserve recognition?
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If yes, describe
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Describe bellow observed practices that require correction or improvement
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Have you corrected or complimented the worker base on these observations?
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Should a follow up observation of this area, task or person take place?
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If yes, describe who and why ?
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Describe any standard procedures, methods or equipment you observed that should be changed in the interest of safety and / or productivity
Completion
- Actions
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Details
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Who
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When
Inspection Participants
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Name and Signature