Wrist Strap Compliance Survey
Document and verify compliance with wrist strap usage and safety protocols.
Employee Full Name
*
First Name
Last Name
Department/Work Area
*
Please Select
Assembly
Testing
Packaging
Maintenance
Quality Control
Other
Date of Compliance Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Did you wear your wrist strap at all times during your shift?
*
Yes
No
Was the wrist strap tested and found to be functioning properly before use?
*
Yes
No (please explain below)
If you answered 'No' to any of the above, please provide details of the issue or incident.
Supervisor/Inspector Name
First Name
Last Name
Additional Comments or Observations (optional)
Submit Compliance Survey
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