Test XSD Template

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General

• Do you enjoy your work?

  Yes

  No

  N/A

• Do you see areas that need improvement?

  Yes

  No

  N/A

• Do you have everything you need?

  Yes

  No

  N/A

Challenges/Barriers to Success

• Are there things slowing down your work?

  Yes

  No

  N/A

• Are there challenges that prevent improving safety?

  Yes

  No

  N/A

• Do you have sufficient time and resources?

  Yes

  No

  N/A

• Do you know how to succeed in the organization?

  Yes

  No

  N/A

• Do you have time to focus?

  Yes

  No

  N/A

Respect

• Does management take your suggestions seriously?

  Yes

  No

  N/A

• Do you feel your work/ideas are respected/followed up?

  Yes

  No

  N/A

Communications

• Do you have the information that you need?

  Yes

  No

  N/A

• Do you feel comfortable coming to my office?

  Yes

  No

  N/A

Culture

• Do you feel we have a good safety culture?

  Yes

  No

  N/A

• Do you have suggestions on how to improve the safety culture?

  Yes

  No

  N/A