InteractiveForm
Interactive Tool

Operational Health Audit — Assessment Form

Use this form during walkdowns, data reviews, and interviews to record consistent, evidence-based observations across safety, quality, delivery, cost, and reliability. Keep answers factual and cite evidence where possible. Save the form and use the outputs to prioritize system-focused countermeasures.

Date of the assessment
Where the audit took place (plant, site, floor, team)
Short description of what was included or excluded
Name and role
Choose the approach used
Rate observed controls, near-miss reporting, PPE use, and hazard mitigation
1 10
Note specific observations, documents, data, incident trends, and who you spoke with
Rate defect control, trends, inspection effectiveness, and rework
1 10
Data points, defect types, recent incidents, test records
Rate schedule adherence, lead-time variability, and backlog
1 10
On-time % metrics, common delays, handoff issues
Rate visible waste, process inefficiencies, and rework costs
1 10
Examples of waste, downtime drivers, inventory issues
Rate equipment/process stability, preventive maintenance, and repeatability
1 10
MTTR/MTBF notes, recent failures, maintenance practices
If yes, describe and escalate immediately per site rules
List the three issues most likely to cause harm, rework, delay, or cost
What parts of the system (handoffs, training, design, schedules, materials, incentives) seem to be creating these issues?
List actions that change the system rather than temporary fixes. Include owner and target date in the note.
Short, measurable checks to confirm the countermeasure reduced risk or improved performance
Is more data or observation required to act?
1 10
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