Run Field Staff Lone Worker Check-In Audit — Free

Audit & Worker Identification

Supervisor conducting this audit

Full name and title of the supervisor completing this check-in audit.

Field staff member being audited

Full name of the lone worker whose protocols are being reviewed.

Date and time of audit

Record the exact date and time this audit is being conducted.

Assignment type for this shift

Select the type of solo field work the worker is conducting today.

Program or department

Name of the program or department the field worker is assigned to.

Route Plan & Assignment Documentation

Written route plan or visit schedule submitted before departure critical (required)

Worker has provided a documented list of addresses, sites, or geographic areas to be visited, in order, prior to leaving the office or starting the shift.

Yes No N/A

Route plan includes full addresses or GPS coordinates for each stop critical (required)

Each visit location is identified with enough specificity (street address, unit number, or GPS coordinates) for emergency services to respond.

Yes No N/A

Estimated time at each location is documented

Route plan includes approximate start and end times for each stop so deviations from schedule can be detected.

Yes No N/A

Route plan includes expected return time or end-of-shift time critical (required)

A clear end-of-shift or return time is documented so the supervisor knows when to initiate a welfare check if no check-in is received.

Yes No N/A

Route plan is accessible to at least one other staff member or supervisor critical (required)

A copy of the route plan is held by the supervisor, a designated colleague, or stored in a shared system — not only on the worker's personal device.

Yes No N/A

Check-In Cadence & Communication Protocol

A defined check-in interval is documented for this shift critical (required)

The program has a written policy or the supervisor has assigned a specific check-in frequency (e.g., every 60 minutes, after each visit, at defined waypoints).

Yes No N/A

Check-in interval (minutes)

Record the maximum number of minutes between required check-ins for this shift. Best practice is ≤60 minutes for standard outreach; ≤30 minutes for high-risk environments.

Worker can clearly state the check-in procedure when asked critical (required)

Supervisor verbally confirms the worker knows: (1) how to check in, (2) how often, and (3) what to do if they cannot check in as scheduled.

Yes No N/A

Check-in method is documented

The method used for check-ins is specified and agreed upon.

Escalation procedure is documented if a check-in is missed critical (required)

There is a written protocol specifying what steps the supervisor or designated contact will take if the worker misses a scheduled check-in (e.g., attempt callback within X minutes, contact emergency services after Y minutes of no response).

Yes No N/A

Worker has completed at least one check-in during today's shift (if shift is in progress)

If the shift has already begun, confirm the worker has checked in at least once per the defined schedule. Mark N/A if audit is pre-shift.

Yes No N/A

Emergency Contact & Distress Signaling

Worker has a designated emergency contact on file for this shift critical (required)

A named individual (supervisor, colleague, or personal emergency contact) is documented and reachable during the worker's shift hours.

Yes No N/A

Emergency contact phone number is current and verified within the last 30 days critical (required)

The emergency contact number on file has been confirmed active and correct within the past 30 days.

Yes No N/A

Worker knows the distress / duress signal or code word

The program has a defined duress signal (code word, app panic button, or agreed phrase) that the worker can use to silently signal danger during a phone check-in.

Yes No N/A

Worker knows to call 911 first in an immediate life-safety emergency critical (required)

Worker can confirm they understand that 911 is the first call in any immediate threat situation, before contacting the supervisor.

Yes No N/A

Supervisor or backup contact is reachable during the entire duration of the worker's shift

The designated supervisor or backup contact is confirmed available (not in meetings, travel, or off-site without coverage) for the full duration of the worker's shift.

Yes No N/A

Communication Device Readiness

Worker has a fully charged mobile phone or communication device at shift start critical (required)

Device battery is at or above 80% at the start of the shift, or a charger/power bank is carried.

Yes No N/A

Mobile device has cellular signal or data coverage for the planned route

Worker and supervisor have confirmed that the planned route has adequate cellular coverage. If dead zones exist, an alternative check-in method is identified.

Yes No N/A

Supervisor's and emergency contact's numbers are saved in the worker's device

Worker does not rely solely on memory; all critical numbers are stored in the device contacts.

Yes No N/A

Backup communication method available if primary device fails

Worker has access to a secondary method (e.g., second phone, radio, known landline at a visit site) if the primary device is lost, stolen, or out of battery.

Yes No N/A

Lone worker app or GPS tracking enabled (if program policy requires)

If the program uses a lone worker app (e.g., StaySafe, SafeZone, or equivalent), confirm it is installed, logged in, and location sharing is active.

Yes No N/A

Personal Safety Preparedness & Risk Assessment

Worker has reviewed any known risk flags for today's clients or locations critical (required)

Worker has checked case notes, client history, or neighborhood risk data for any prior incidents of aggression, unsafe conditions, or other hazards at today's visit sites.

Yes No N/A

Risk level assigned to today's assignment

Supervisor and worker agree on the overall risk level for today's shift based on client profiles, locations, and environmental factors.

High-risk assignments have a modified check-in interval of ≤30 minutes

If today's risk level is 'High' or 'Critical', the check-in interval has been reduced to no more than 30 minutes per shift. Mark N/A if risk level is Low or Medium.

Yes No N/A

Worker knows the de-escalation and exit protocol for unsafe situations

Worker can describe the steps to safely exit a visit if a client or environment becomes threatening (e.g., verbal de-escalation, excuse to leave, do not re-enter).

Yes No N/A

Required PPE or safety equipment is present and in serviceable condition

Any PPE required by program policy (e.g., gloves, N95 mask for health workers, personal alarm, ID badge) is present, undamaged, and ready for use.

Yes No N/A

Supervisor Sign-Off & Corrective Actions

All critical deficiencies identified in this audit have been resolved before worker departure critical (required)

If any critical item was marked 'No' during this audit, confirm that corrective action has been taken and the item is now compliant before the worker is cleared to depart.

Yes No N/A

Non-critical deficiencies noted and corrective actions assigned

List any non-critical items that were deficient, the corrective action assigned, and the responsible person and due date.

Worker is cleared to proceed with today's field assignment critical (required)

Supervisor confirms the worker has met all critical safety requirements and is authorized to begin the shift.

Yes No N/A

Overall lone worker safety protocol compliance rating for this worker

Supervisor's holistic assessment of the worker's lone worker safety readiness based on this audit.

Supervisor signature

Supervisor signature confirming this audit was conducted and findings are accurate.

Additional notes or observations

Any additional context, observations, or follow-up items not captured elsewhere in this audit.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Run: Field Staff Lone Worker Check-In Audit

Audit & Worker Identification

Route Plan & Assignment Documentation

Check-In Cadence & Communication Protocol

Emergency Contact & Distress Signaling

Communication Device Readiness

Personal Safety Preparedness & Risk Assessment

Supervisor Sign-Off & Corrective Actions

Get your results