Information

  • Site conducted

  • Conducted on

  • Prepared by

  • Personnel

  • Location

  • When conducting audits, choose a sample area of the department. Answer all questions and take pictures for all questions. If an area is lacking a computer, or desk, etc. choose another sample area to complete the audit.

Work Surfaces, Workstations and Floors (72 pts.)

  • Work floors and surfaces.jpg
  • Do the floors look like the standard photo?

  • Notes On Deficiencies.

  • Take a photo of your area's floors

  • Work Station.jpg
  • 2 - Does the workstation look like the standard photos? (Yes = 40 pts., Needs Improvement = 20 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a photo of your area's workstation

  • Check this box if work stations have major defects that maintenance needs to fix.

  • Enter the work order number and/or project charter in reference to this area and any additional notes.

Machines, Equipment, Conveyors, and Tooling (96 pts.)

  • Safety Equipment.jpg
  • 3 - Are your emergency equipment and emergency exits free from blockages and labeled for visibility? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on Deficiences

  • Take a picture of your emergency equipment

  • Check this box if the emergency equipment and exits signs are not working or in poor condition.

  • Enter the work order number and/or project charter in reference to this area and any additional notes.

  • PPE.jpg
  • 4 - Does the PPE in the area looked well stocked and protected from getting dirty or damaged? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's PPE

  • Machines and equipment.jpg
  • 5 - Do the machines, equipment, conveyors, and assembly tables look clean, in good condition, and in their proper place? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's machines, and equipment

  • Check this box if machines or equipment are in poor working condition, if guards are damaged, or cables are a trip hazard.

  • Enter the work order number and/or project charter in reference to this area and any additional notes.

  • Tools.jpg
  • 6 - Do the tools and gauges in the area look clean, in good condition, and are in their proper homes? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on deficiences

  • Take a picture of your area's tools and gauges

Supplies, Kanban Shelves, Material Staging Areas (On-line and Off-line Storage) (72 pts.)

  • Supplies.jpg
  • 7 - Do the supply areas look well stocked and have unnecessary items removed? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on deficiences

  • Take a picture of your area's supplies

  • Check this box if shelves are in poor condition and maintenance needs to fix it.

  • Enter the work order number and/or project charter in reference to this area and any additional notes.

  • Mobile Desk.jpg
  • 8 - Does the desk and documents look clean and organized? (Yes = 24 pts., Needs Improvement = 12 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's desk

  • Check this box if computer equipment is not in good working condition.

  • Enter help desk ticket and/or project charter in reference to this area and any additional notes.

  • Cleaning.jpg
  • 9 - Do the cleaning supplies look stocked, labeled, and in proper home? (Yes = 24 pts, Needs Improvement = 12 pts, No = 1pts)

  • Notes on deficiences

  • Take a picture of your area's cleaning supplies

Trash and Scrap

  • Trash and Scrap.jpg
  • 10- Are the trash and scrap areas labeled? (Yes - 12 pts., Needs Improvement = 6 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's trash and scrap

Communication Boards, Check Sheets, Standard Work (60 pts.)

  • SQSP.jpg
  • 11 - Does the department's postings and communication boards look like the standard photo? (Yes = 16 pts., Needs Improvement = 8 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your department's SQSP board

  • 12 - Are check sheets complete, up-to-date, and in good presentation (no frayed edges, all words are legible)? (Yes = 16 pts., Needs Improvement = 8 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's 5S check sheet

  • Standard Work.jpg
  • 13 - Is the standard work book organized, up-to-date, pages are in good presentation ( no rips, words a legible)? (Yes = 16 pts., Needs Improvement = 8 pts., No = 1 pts.)

  • Notes on deficiencies

  • Take a picture of your area's standard work book

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.