Title Page
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Client / Site
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Conducted on (Date and Time)
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Inspected by
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Location
S1 – Sort – SEIRI
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No irrelevant reference materials, documents, drawings, etc.
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No excess pieces of equipment, documents, etc.
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Storage area is defined to store unneeded items and out-dated documents.
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Standards for eliminating unnecessary items exist and are being followed.
S2 – Set in order – SEITON
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Desks and cabinets are free of accumulations of papers and other objects.
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All tools and equipment are stored in a fixed place.
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Tools and equipment are well organized for ease of take and return.
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Labeling of cabinets, shelves and files allows immediate identification.
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Documents are filed in accordance with the Record Retention Guidelines.
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Displays are tidy, free of clutter, labeled and up-to-date.
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Safety equipment easily accessible and in good condition.
S3 – Shining – SEISO
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The floor is kept clean and no signs of damage.
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Walls and ceilings are in good condition and free from dirt and dust.
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Racks and cabinets are kept clean and in good condition.
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Equipment and tools are kept clean and in good condition.
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Desks, tables and other furniture are kept clean
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Lighting is enough and the angle and intensity of illumination are appropriate.
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Good movement of air exists through the room.
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Trash containers are emptied on a regular basis.
S4 – Standardize – SEIKETSU
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Visual controls and display boards are used and regularly updated.
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Procedures for maintaining the first three S's are being displayed.
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5S checklists, schedules and routines are defined and being used.
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Everyone knows his responsibilities, when and how.
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Regular audits are taking place using checklists and measures.
S5 – Sustain – SHITSUKE
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5S seems to be the way of life rather than just a routine.
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Success stories are being displayed (i.e. before and after pictures).
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Rewards and recognition is part of the 5S system.
Completion
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Recommendation
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Full Name and Signature of the Inspector