Title Page

  • Conducted on

  • Prepared by

  • Location
  • Receiving Office Cleanliness: Surfaces including tops of desk and office equipment, and floor are clean and area is maintained according to posted 5S Expectation and Standard.

  • Painted Surfaces: Painted surfaces including walls, doors and yellow painted items are clean and paint is in good condition. Action plan created

  • Floor paint/markings: Floor is clear of debris and clutter

  • Moveable Items: Homes for all moveable items are clearly defined. For example, with signage or shadow boxing.

  • Lighting: Lighting is sufficient for safe operation and identification of materials. Trailer lights are all functioning.

  • Areas along walls: Areas along walls are clear of debris and any other items unless in clearly designated locations.

  • Dock Doors: Dock plates and doors are clean, operating properly

  • Signage: Existing signage is in good condition and is sufficient to identify various storage locations, safety issues

  • HVAC: HVAC is in good working order, maintains set temperature, and appears clean.

  • MRO Area: MRO Material is contained within designated area.

  • Slip/Trip Hazards: Area is free of trip/slip hazards.

  • Please correct condition immediately.

  • Computers/Printers/ Scanners & Related Wiring: Equipment is clean and appears to be operating properly. Cables/wires are well organized and secure.

  • Waste Removal: Standard Waste, Paper, Plastic/Bottle, and Compost bins are in proximity. Bins are clean and not overflowing.

  • Electrical Panels: Verify that nothing is stored on top of panels, that they are secured and in good condition, and that there is 3' of clearance.

  • Please correct condition immediately.

  • Floor: Floor appears clean and recently swept/mopped.

  • Shadow Boards: Boards are fully stocked and items are returned when not in use.

  • Outside Receiving: Empties are organized.

  • Outside Receiving: No items are on the retaining wall.

  • Outside Receiving: There are not items that don't belong in the area. (If there are, find the owner for removal). Action plan created

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.