Title: Zone: Location: Ref: Rev.

& Date:
5 “S” Score sheet
Ownership:
Layout.

Ref. Line (Eg. Columns, Machines & Etc.)

Team involved:
Photo

A. Work station must Free from

1. Dust, Dirt, Oil & cob web free Floor, walls,
Machines & Materials
தததத, ததததததத, ததததததத & ததததததத ததத
தததததத ததத, ததததத, தததததததததததத &
ததததததததத
2. Leak free Gas, Air & water lines
தததத, தததததத ததததததத தததத ததததத தததததத
ததததததததத
3. Damage & joint free electrical system
ததததத ததததததத ததததததத தததததத தததத
தததததததத &
ததததததத

SL Check the following W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13

Job specific PPE’s & Safety items must be used
1 ததததததததததத தததததததததத ததததததததத
தததததததததததததத தததததததத

2 Work station must free from unwanted items (Ref. A)

தததத தததததததத தததததததத ததததததததத ததததத தததததததத

3 Waste Management practices (Primary segregation)

ததததத தததததததத ததததததத ததததத தததததததத
Availability of all wanted items ® in its place
4 ததததததத ததததததத ததததததததததத ததததததததத தததததததத
தததததத தததததததத

5 Shine work place

தததததததத தததத தததத
5S Layout to be updated & Closure of audit
6 observation
5S ததததததத ததததததததததததததத தததததததத

Total
F/MR/5S/01 Page 1 of 6
 Machine Tools & Tackles Gauges & Instruments Materials

Name Id Name Id Name Id Name Id

Audit Ref. Closure

SL Auditor Audit Observation
Date Sl. no Status

F/MR/5S/01 Page 2 of 6
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 Audit Ref. Closure
SL Auditor Audit Observation
Date Sl. no Status

F/MR/5S/01 Page 4 of 6
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