5S Audit Form Rev 2

• Audit Title

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

Scoring method

• "Scoring Method:
  0 = 'No', where the only choice is '0' or '4', otherwise it means 'not at all'
  1 = Some evidence of a plan, but very little conformance
  2 = About half the instances noted were in conformance
  3 = Instances noted were mostly in conformance, but one or more problems were found
  4 = 'Yes', where the only choice is '0' or '4', otherwise complete conformance with no problems noted"

1.0 - 5S Audit Form

• 1.1 - Is unused equipment and machinery eliminated from the plant?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.2 - Are aisles and doorways free from material and blockages?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.3 - Are all tripping hazards and obstructions eliminated?

  4 - Yes

  2 - Half

  0 - No
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• Corrective Action

• Person Responsible

• 1.4 - Are all work area boundries clearly marked?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.5 - Are storage places for all tools and equipment designated and marked?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
Tap to enter information

• Corrective Action

• Person Responsible

• 1.6 - Are storage places for all work in process designated and marked?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
Tap to enter information

• Corrective Action

• Person Responsible

• 1.7 - Are all pipes, controls and guages identified and labeled? Are guages and indicators labeled to clearly show the normal operating range?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
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• Corrective Action

• Person Responsible

• 1.8 - Is the floor and machinery free from all foreign material?

  4 - Yes

  2 - Half

  0 - No
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• Corrective Action

• Person Responsible

• 1.9 - Are machines in good repair per calibration and PM stickers?

  4 - Yes

  2 - Half

  0 - No
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• Corrective Action

• Person Responsible

• 1.10 - Are sources of dust, dirt and foreign material under control?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
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• Corrective Action

• Person Responsible

• 1.11 - Are cleaning and checking schedules available and in documented use?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.12 - Are up to date work instructions, including quality checks, available and in use at all work stations?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.13 - Are all bins and parts properly identified and tagged?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.14 - Is everyone wearing proper safety and ESD gear?

  4 - Yes

  0 - No
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• Corrective Action

• Person Responsible

• 1.15 - Are all unused tools and equipment properly stored?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
Tap to enter information

• Corrective Action

• Person Responsible

• 1.16 - Are all raw materials and work in process properly stored?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
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• Corrective Action

• Person Responsible

• 1.17 - Are all personnel fully trained in the tasks they are responsible for, and regularly tested?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
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• Corrective Action

• Person Responsible

• 1.18 - Is there a regular auditing process to verify compliance with all elements of the production and safety systems?

  4 - Yes

  3 - Mostly

  2 - Half

  1 - Some

  0 - No
Tap to enter information

• Corrective Action

• Person Responsible

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• Auditor's signature

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