Title Page

  • SWI and Rev #

  • Auditor

  • Employee audited

  • Department

  • Enter Dept Name

  • Shift

  • Conducted on

Documentation Control

  • Does the SWI Rev.# of the sign off copy match the current controlled version on the network?

  • Does the training matrix reflect that the worker has been sufficiently trained for the task he/she is performing and is the worker signed-off on the SWI and associated Mod. Bulletins?

  • If a Modification Bulletin reflects any permanent changes to the process, has the SWI been updated?

  • Are all stakeholders (Eng, Mgr, Day TL, Aft TL, Night TL, Quality) signed off on the revision?

  • Can worker locate ALL SWI's and/or Modification Bulletins for this job/station?

Use of work instructions. (Observe 5 to 10 cycles)

  • Is the worker using PPE as intended?

  • Please STOP, correct issue, and record the nature of problem.

  • Does the worker follow the order of major steps defined in the SWI? (no prompt)<br>(If not, possible actions include additional employee training or issuing a Form 0504 Modification Bulletin and initiating a permanent SWI change using Form# 4854.).

  • For each process step, can the worker state key point(s) and explain why they're important? (prompt)

Leadership in Standardized Work.

  • Safety, ergonomic and environmental conditions appear OK?

  • Please STOP, correct issue, and record the nature of the problem.

  • Have you considered if there are opportunities to further mitigate risk (as reflected on the job Risk Assessment)?

  • Did you ask the worker if he/she has any ideas for improvement?

  • What are the employee's idea(s) for improvement, if any?
  • Record idea

  • Tools, gauges, scales, fixtures, aids, samples: available and in good condition, and calibration stickers are up to date?

  • ALL action items from last audit of this SWI have been 100% closed by the due date?

  • Auditor: Please share results with worker and TL (if applicable). Assign tasks as required and record on I&A List.

  • Auditor

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.