Title Page

  • Site Conducted

  • Conducted on

  • Prepared by (Name + Last Name)

  • Location

SORT: "If in doubt move it out"

  • No unnecessary items

  • All items not necessary for performing work are removed from the workplace; only tools and products are present at workstations. <br>No items are on top of machines, cabinets, or equipment. No personal items.

  • Documentation binders

  • Only binders containing documentation necessary for operations. <br>Only current and relevant paperwork is stored in the area.

  • OTHER COMMENTS

SET IN ORDER: "A place for everything!"

  • Material storage

  • Boxes, containers and materials are necessary and stored neatly in clearly labeled shelves of cabinets. Large items are stored on the floor in correctly color-coded areas. Stacked items are not crooked or in danger of toppling over.

  • Tools

  • Tools, testing equipment and grader screens stored neatly in designated locations; storage is designed to ensure cleanliness and prevent damage. Items are in a serviceable and safe condition.

  • Cleaning equipment & materials

  • All cleaning equipment and materials are easily accessible and stored neatly in a clearly labeled location. (Hoses coiled)

  • Emergency equipment

  • Fire-fighting and other emergency equipment is unobstructed and correctly stored. Emergency stop switches/breakers are color-coded, easily visible and easily accessible.

  • Walkways/Doors

  • Walkways are clearly marked. Walkways and exits to the doorway are free of obstructions. All doors are closed.

  • Glass & Hard Plastics

  • Check if all intact.

  • OTHER COMMENTS

SHINE: "See it...Clean it!!!"

  • Floors/Walls/Ceilings (cleaning)

  • Floors, walls and ceilings clean & free of debris and in good repair.

  • Equipment (cleanliness)

  • Machines, equipment and workstations are clean and free of dust and debris.

  • Equipment (maintenance)

  • All machines and equipment are in good condition. Safety guards and signs are correctly installed. No fluid leaks, frayed electrical cords, or worn airlines.

  • Visual management systems

  • All performance and information boards are neat, tidy and up to date.

  • OTHER COMMENTS

STANDARDIZE: "What's the standard?"

  • 5S control (posted)

  • Daily 5S checklists are completed, signed off and corrective actions implemented?

  • Work Instructions

  • Standard Work, Work Instructions, SOP's are clearly posted if required. Only most recent version is present.

  • OTHER COMMENTS

SUSTAIN: "Create a Culture!"

  • 5S Weekly Audits

  • Audits done on a weekly basis by trained auditors.

  • 5S Weekly Audits

  • Identified actions completed & signed off from last audit.

  • OTHER COMMENTS

TOTAL

  • Score out of 16

  • Percentage (e.g. 14/16 x 100 = 88%)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.