Gemba Checklist (Office & Locker rooms)

• Sito di conduzione

  Select

• Condotto su

  Date

• Preparato da

• Posizione
  Address

General Information

• Department Interested

• List of participants

Office

• General condition of cleaness?

  Good

  Fair

  Poor

  N/A

• Everything is working?

  Yes

  No

  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

• Cleaning log is < 24h?

  Sì

  No

  N/A

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

  Yes

  No

  N/A

Lockers F

• 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

Lockers M

• 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

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