Gemba Checklist (Bunker + EST)

• Sito di conduzione

  Select

• Condotto su

  Date

• Preparato da

• Posizione
  Address

General Information

• Department Interested

• List of participants

Dock General Cleaness

• Are the docks closed when not used?

  Yes

  No

  N/A

• General condition of cleaness?

  Good

  Fair

  Poor

  N/A

• Orphan equiment?

  Yes

  No

  N/A

• Is there any tools that supposed not to be in the area?

  Yes

  No

  N/A

• Findings

• Is there any ongoing action to keep good general cleaness?

  Yes

  No

  N/A

• Docks are working?

  Yes

  No

  N/A

• Indicate the not working docks

Dispatch Point

• General conditions

  Good

  Fair

  Poor

  N/A

• Do you have everything you need for this process?

  Yes

  No

  N/A

• Kindly specify your needs

• Labels are present?

  Yes

  No

  N/A

Safety

• Fire extinguisher are reachable?

  Safe

  At Risk

  N/A

• Escape isles are free?

  Safe

  At Risk

  N/A

Bunker

• General Cleaness of Bunker

  Good

  Fair

  Poor

  N/A

• General Safety of Bunker

  Safe

  At Risk

  N/A

• Are firedoors working?

  Yes

  No

  N/A

• Are fire extinguisher working?

  Yes

  No

  N/A

• Orphan equipment in Bunker?

  Yes

  No

  N/A

• Are mixed type of HAZMAT together?

  Conforme

  Non conforme

  N/A

Completion

• Are there any other question(s) you want to raise?

  Yes

  No

  N/A

• List down your question(s)

• Observations and Recommendations

  Yes

  No

  N/A

• undefined

Findings

• Problem 1

• Problem 2

• Problem 3

• Problem 4

• Problem 5

• Full Name and Signature of the Inspector

  Sign