TIPCO COMPLEX

OCCUPATIONAL HEALTH & SAFETY MANAGEMENT SYSTEM AUDIT

TIPCO F.S.I. TNMSC

Page OBSERVATION REPORT

Date: _________________
AUDITED DEPARTMENT: DISCUSSED WITH (PERSONS INTERVIEWED):

A. ESTABLISHED OBSERVATION:

POSITIVE NEGATIVE
(POTENTIAL DEVIATION)

ACKNOWLEDGED BY (MANAGER/TEAM LEADER/SUPERVISOR): ___________________________________________ ASSESSOR: LEAD ASSESSOR:

B. ANALYSIS BEFORE ARRIVING TO THE PREVENTIVE ACTION:

C. PREVENTIVE ACTION implemented by the Department:

Date of Implementation:

F. FOLLOW-UP AUDIT:

Date: ________________________________
LEAD ASSESSOR / ASSESSOR

STATUS CLOSED OPEN

SMS-C-024 CERTIFIED CORRECT:

INTERNAL HEALTH & SAFETY AUDIT CHAIRPERSON

TIPCO COMPLEX

H & SAFETY MANAGEMENT SYSTEM AUDIT

of ____

BSERVATION REPORT Date: _________________

NEGATIVE
(POTENTIAL DEVIATION)

________________________________
LEAD ASSESSOR / ASSESSOR

STATUS OPEN

INTERNAL HEALTH & SAFETY AUDIT CHAIRPERSON

Page

____

of

____

A. ESTABLISHED OBSERVATION:

POSITIVE NEGATIVE
(POTENTIAL DEVIATION)

ACKNOWLEDGED BY (MANAGER/TEAM LEADER/SUPERVISOR): ___________________________________________ ASSESSOR: LEAD ASSESSOR:

B. ANALYSIS BEFORE ARRIVING TO THE PREVENTIVE ACTION:

C. PREVENTIVE ACTION implemented by the Department:

Date of Implementation:

F. FOLLOW-UP AUDIT:

Date: ________________________________
LEAD ASSESSOR / ASSESSOR

STATUS CLOSED OPEN

SMS-C-024 CERTIFIED CORRECT:

INTERNAL HEALTH & SAFETY AUDIT CHAIRPERSON