5SAuditForm

NAME: _______________________ DATE: ________________ TEAM: ________________

Foreachstatement,checkthescorethatbestrepresentsthe5Slevelforeachitemineachcategory.
Totalscoreforeachcategoryandthenaddcategorytotals.

SORT Unacceptable Poor Good Excellent WorldClass

Sort out necessary & unnecessary items. The items Noevidence Only Applied Thoroughly Continuously
deemed unnecessary and not being used should be shown evident and evident lookingfor
removedfromthearea(incl.Generalarea,workstations, hereand evident and waystomake
personalstorageareas,deskdrawers,filingcabinets,PC there inmost appliedto evenmore
electronicfiles,safe) areas allareas improvements

1. Items/suppliesonsurfaceshavebeensorted, 1 2 3 4* 5
separatingneeded(usedfrequently)fromunneeded Details:
(usedinfrequentlyornotatall).
2. Items/suppliesinbookcasesoronshelveshave 1 2 3* 4 5
beensorted,separatingneededfromunneeded Details:
(availableelectronicallyornotneededatlocation).
3. Itemsincupboardsordrawers,includingdeskand 1 2 3* 4 5
filedrawers,havebeensorted,separatingneeded Details:
fromunneeded(availableelectronicallyornot
neededatlocation).
4. Itemsonfloorshavebeensorted,separating 1 2 3* 4 5
neededfromunneededeliminatingfloorpilesand Details:
allcordsaresafelycontained.
5. Neededitems(incupboards,drawers,bookshelves, 1 2 3* 4 5
onsurfaces,orfloors)havebeenplacedatthe Details:
closestlocationtowheretheyareusedthemostto
minimizethewasteofmotion.
6. Unneededitemshavebeenremovedfromthework 1 2 3 4* 5
area. Details:
7. Workagreementsfortheabovearedocumented 1 2 3 4* 5
andallstaffknowwheretofindtheagreements.
Details
TotalScore 24

SETINORDER Unacceptable Poor Good Excellent WorldClass

A place for everything and everything in its place so it
shouldbeeasytofind
8. Locationsofneededitemsarelabeledanditemsare 1 2 3 4* 5
incorrectlocations. Details:
9. Required quantities for needed items are 1 2 3 4* 5
determined (par levels), including items in desk Details:
drawersandinbookshelves.
10. Locationsformovableitemsarelabeled,anditems 1 2 3 4* 5
are placed in correct locations (white board/ Details:
laminatedcard/labelonwallcanbeused).
11. Visual controls and indicators are established 1 2 3* 4 5
including: Posted map of area, including individual Details:
roommaps.
12. There are Kanbans for reorder (if used by group 1 2 3 4* 5
agreement). Details:
13. There is Labeling indicating contents of drawers and 1 2 3 4* 5
cupboards (a new person should be able to locate Details:
withoutassistance).
TotalScore 23
5SAuditForm

SHINE Unacceptable Poor Good Excellent World

Keepworkareacleanandreadytouse.Inspectregularly Class
toensuresortandsetinorderaremaintained.
14. Work areas and equipment are stocked and 1 2 3 4* 5
organized on a consistent basis according to 5S Details:
agreementsandschedules.
15. Members of the work group follow 5S agreements 1 2 3* 4 5
onadailybasis. Details:
16. Sources and frequency of 5S problems are 1 2 3* 4 5
documentedaspartofroutineworkbyallstaff.
Details:
17. Surfacesarecleanedandclearofdustanddebris. 1 2 3* 4 5
Details:
18. Checklists are utilized to identify ongoing Shine 1 2 3* 4 5
dutiesandthestatusoftheseareuptodate. Details:
TotalScore 16

STANDARDIZE Unacceptable Poor Good Excellent World

Maintain the first three Ss and have an awareness of Class
improvingneatness.
19. Thereisa5Sagreementinplaceandallemployees 1 2 3* 4 5
knowwhereitislocated. Details:
20. Leadershipcanexplainwhy5Sisimportant. 1 2 3* 4 5
Details:
21. Allstaffcanexplaintheimportanceof5S. 1 2 3* 4 5
Details:
22. There is a standard process for training and 1 2 3* 4 5
orientingnewstafftothe5Ssystem.
Details:
23. There is a process in place to ensure unnecessary 1 2 3* 4 5
itemsdonotcreepbackintotheworkarea. Details:
TotalScore 15

SUSTAIN Unacceptable Poor Good Excellent WorldClass
The5SDisciplineisembeddedsothatitbecomesaway
oflife.5Sisnolongeraneventbutroutine.
24. 5S plans and action updates are clearly displayed 1 2 3* 4 5
andcurrent. Details:
25. Success stories are displayed and confirmed for 1 2 3* 4 5
improvement. Details:
26. Staff5Srolesareclearlyidentified. 1 2 3* 4 5
Details:
27. Department audits and subsequent improvement 1* 2 3 4 5
plansaredisplayedandcurrent. Details:
28. Are work instructions and procedures available in 1* 2 3 4 5
the workplace regularly reviewed/kept up to Details:
date?
29. Are display boards, activity charts, notice boards, 1* 2 3 4 5
etc.uptodateandregularlychecked? Details:
TotalScore 12

Total the category Level1:126 Level4:79104

scorestofindyour
5Slevel: Level2:2752 Level 5: 105 130
Level3:5378
5SAuditForm

LeanCulture
HowSustainableisyour5SWorkEnvironment?
The following elements are based on research into the primary influencers of where an individual or group can and will
sustainanewwayofdoingthings.Assessthecurrentstateforyourteamontheseitems.
Element Intermsof5S Yes No
Credibility Canmoststaffdescribethebenefitsclearly,ordotheyatleasttrustthatbenefitshavebeen *
achievedelsewhereandarepossiblehere?
Benefits Havemoststaffexperiencedareductioninwasteandextraeffort,withthingsrunningmore *
smoothly,becauseofyour5Sefforts?
Adaptability Are you confident about overcoming any internal pressures to sustain a 5Sd environment *
andcontinueimproving?
Can your 5S work be sustained without overreliance on a particular individual, group, *
technologyormoney?
StaffTraining Doyouhaveaprocesstoidentifygapsinknowledge,traintofillthesegaps,andcontinueskill *
developmentinyourstaff?.
Systems Does your infrastructure (e.g., policies, communications, job descriptions, facilities, *
equipment)supportbeinga5Sdworkplace?
Attitudes Domoststaffthinkbeing5Sdisabetterwayofdoingthingsthattheywanttopreservefor *
thefuture?
Leadership Doesyourstaffseethedepartment/sectionleadership(administrativeandclinical)personally *
involved,demonstrating5Sintheirspaces,andhelpingtheteamwithsustainability?
Monitoring Do you have an effective process to monitor progress, act on needs and communicate *
results?
Culture Doesyourteamhaveacandocultureandahistoryofsuccessfulchange/sustainability? *

ThemoreitemswithaNoanswer,themorevulnerableyourteamistobackslidingonyour5Sprogress.
Identifystrategiestoaddresstheweakpointsinthecomingmonths.

ActionPlan

Description Actionsummary Responsibility

We are currently working with in a clinic All the staff were involved with pulling All staff will be
setting and with their schedule having finally out all the supplies and either getting rid responsible to
been able to get all the staff involved in a 5S of them relocating it, or grouping it with maintain these
project. the like supplies in that room. changes.
We selected their Procedure room, that all Staff were at first hesitant to move Supplies were
the staff use, and needed some special anything or dig and start sorting, but placed in either 2
attention. then really started to enjoy it when they bins or in a bin
started finding all those Lost items! that will have a
Kanban
Staff were very receptive and thankful for
helping them with this It seems like they
always say that this was something that they
have wanted to do, but Never take the time
to do it!!

Next week when all the items are

entered into our database I will print
Labels and make the Kanbans that they
will use for the reordering of supplies.
Plant operations will also be contacted
5SAuditForm
regarding a cabinet with a drawer to
store supplies that are currently on the
counter that could be store in an open
area is shelving and a door could be put
in place.