Audit

Employee Name

Department:

Ship or Location:

Violation Type:

Specific Action:

Supervisor Name:

Witness:

Witness Signature

Corrective Action Taken/Req:

Penalty:

Penalty- Other:

Employee Signature
Select date
Supervisor Signature
Select date
Safety Manager Signature
Select date

Comments:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.