Work Surfaces, Workstations and Floors (72 pts.)

  • Work floors and surfaces.jpg
  • 1 - Do the floors in the working area look like the standard photos? (Yes = 32 pts., Needs Improvement = 16 pts., No = 1 pts.)

  • 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 - Does your emergency equipment and emergency exits look like the standard photo? (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 look like the standard photo? (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 like the standard photo? (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 like the standard photo? (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 like the standard photo? (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 like the standard photo? (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 like the standard photo? (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- Does the trash and scrap look like the standard picture? (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 SQSP board 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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.