Procedure being audited: _______________________________________________________
Name of Auditor: _____________________________________________________________
1: Print Procedure in hard copy
2: Review Procedure with staff member/s responsible for activity in daily role 3: Obtain samples of work to which procedure relates 4: Make notes on procedure, in hard copy, identifying work sample obtained 5: Note any Non-conformance with procedure in hard copy 6: Note summary of Non-conformance:
7: Note Recommended Corrective Action: (eg training, modification of procedure)
8: Person delegated to undertake corrective action: __________________________________
To be completed by person undertaking corrective action:
9: Action to be undertaken:
10: Date action to be completed by: ___/____/_______
Comments:
Date Completed: ___/____/_______ Signature:________________________________