Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Production Office
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5S
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Hazard Class
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Lighting
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Hazard Class
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Comments
Hazardous Waste Storage
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5S
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Hazard Class
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Lighting
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Hazard Class
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Storage Barrels (In good condition, 'Hazardous waste' label, lid properly secured)
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Hazard Class
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Comments
Restrooms
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5S
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Hazard Class
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Lighting
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Hazard Class
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Comments
Janitor's Closet
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5S
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Hazard Class
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Lighting
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Hazard Class
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Comments
First Aid Room
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AED System Check (Green button)
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Hazard Class
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AED Battery Expiration Date (Remove battery cover)
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Hazard Class
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AED Supply Contents (List in cabinet. Supplies in AED case.
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Hazard Class
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Latex Gloves (1) - Near Sink
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Bloodborne Pathogen Kit (1) - Under Sink
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Wool Blanket (1) - Wall Mount
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Triangular Badge (1)
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Scissors (1)
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Resuscitation Barrier (1)
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Gauze Roll - 3" (2)
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Ice Pack (2)
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Flex Wrap Roll (2)
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Hydrocortisone Cream (10)
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Burn Treatment (1)
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Adhesive Tape (1)
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Eye Wash (1)
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Eye Covering (1)
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Gauze pads 4"x4" (10)
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Gauze Pads 3"x3" (10)
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Gauze Pads 2"x2" (10)
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Iodine Wipes (20)
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Comments
Bondcell/ Super Station Zero
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5S (Clean Machines, Floors clean & clear, Matting in place)
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Hazard Class
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Lighting
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Hazard Class
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Super Station Zero (Guarding in place, Machine in good condition, Middle of conveyor clear)
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Hazard Class
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Bond Cell Eye (Cage clean, Operator stations in good condition, Matting in place)
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Hazard Class
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Bond Cell Eye Wash (Purge and refill every 4 months, Sign & Date)
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Hazard Class
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Comments
Headlamp Sub
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5S (Material, Floor, Matting, etc)
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Hazard Class
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Monorail (Condition, Usage, etc)
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Hazard Class
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Carts (Condition, Usage, etc)
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Hazard Class
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Comments
Carousel
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5S (Clean stations, Center organized)
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Hazard Class
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Fixtures (Good condition, wear & tear)
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Hazard Class
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Lighting
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Hazard Class
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Comments
DS AGS
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5S (Material, Floor, Stations, etc)
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Hazard Class
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Lighting
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Hazard Class
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CAC Station (Material, Floor, etc)
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Hazard Class
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Comments
Grille Sub
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5S (Material, Floor, Workstation, etc)
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Hazard Class
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Test Station 2 Light Curtain
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Hazard Class
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Comments
ECM Sub
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5S (Floor, Matting, Lighting, Material)
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Hazard Class
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ECM Racks (Good condition, Uniform, etc)
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Hazard Class
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Lift Assist (Being used, working, etc)
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Hazard Class
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Conveyor (Good condition, working, etc)
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Hazard Class
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Diesel Sub (Fixtures, Guarding, etc)
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Hazard Class
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Comments
Shipping System
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5S (Debris, Lighting, etc)
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Hazard Class
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Guarding
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Hazard Class
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Comments
Production Parking Lot
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Employee Entrance (5S, Material, Stairs)
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Parking Lot (Walking surfaces, Smoking shelter 5S, Oils, Ice, etc)
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Backup Generator (No material storage, No signs of oil/gas release, Barriers effective)
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Comments
