MSCG GEMBA Walk

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Area to be walked

• Attendees

Observation 1

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

Observation 2

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

Observation 3

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

Observation 4

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

Observation 5

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

Observation 6

• What was observed

• Who was completing the task

• Assessment of task being completed

  Very Good

  Acceptable

  Needs Improvement

  N/A

• Were any Health And Safety Issues Noted On The GEMBA Walk

  Safe

  At Risk

  N/A

• Have tasks been assigned SMART?

  Yes

  No

  N/A

• Sign Off

  Sign