PROPRIETARY (Applies to Completed Forms Only)
Safety Assessments FINDING WORKSHEET Dept::
Date:
Protocol:
Assessor:
Planning Hazard Notification
Training Recordkeeping
Control No: QSF-
PROCESS: Reporting
Permitting Inspections/Review
Page 1of 1
Monitor/Test Operational Controls
Note: Please do not provide the completed Form to the site. This form must be submitted to the Assessment Team Leader only
FINDING Description DRIVER:
Regulatory
Type of Finding:
Company only
Process
Other
Management System
LAI
==========================================================================================================================================================================
The following observations were made regarding the NAME OF THE PROTOCOL: - X of X emoployes did not……….. - X of X records did not…………
Type of Finding:
Repeat Finding
Imminent Danger
Risk Rating (Work with the Finding Risk Ranking form to identify numbers for the following elements) 1. People Exposed 2. Fatality or severe permanent disability 3. Asset/property/production/ financial losses in excess of $250,000 4. Page one news story in major local newspaper 5. Regulatory consequence in excess of $10,000 Root Cause: Planning: P-
Implementation: I-
• • • • • •
P-1=Process/Documentation Lacking P-2=Training / Awareness P-3=Resource Allotment / Management Support P-4=Lack of Awareness as to the Requirement P-5=Poor Understanding of Requirement P-6=Accountability Not Established
• I-1=Actions Inconsistent with Procedures • I-2=Controls Do Not Obtain Required Results • I-3=Failure To Check Activities / Actions • I-4=Higher Priority Conflicts • I-5=Other, Please Explain Further analysis control No: Fill by Quality: RCN-
•
P-7=Other, Please Explain
BOEING SHANG HAI PROPRIETARY