D-OPX-FORM-401

Revision A
7/27/2020
Gemba Walk Report Page 1 of 2

1. Purpose
1.1 Provide a means of recording wastes, variances, actions, responsibilities, dates, and 5S+2 maturity during Gemba Walks.
1.2 Provide a means of reviewing the previous Gemba Walk's activities and resulting actions.

2. Scope
2.1 This document applies to all Dura-Line production plants.

3. Applicable Documents
3.1 D-OPX-WORK-101 Gemba Walk Guidelines
3.2 D-OPX-WORK-100 5S+2 Program Guidelines
3.3 D-OPX-WORK-200 5S+2 Standards and Levels

4.0 Instructions
4.1 Complete this report at every Gemba Walk.
4.2 Identify wastes, variances, actions, responsibilities, dates, and 5S+2 maturity during each Gemba Walk.
4.3 Review the prior Gemba Walk Report during the next scheduled Gemba Walk.

5.0 Revision History and Change Details

Rev Date Originator(s) Change Details

Jabil Proprietary Confidential - All rights reserved Page 1 Cover Page

 D-OPX-FORM-401
Revision A
7/27/2020
Gemba Walk Report Page 2 of 2

Gemba Walk Information

Gemba Walk Zone/Subzone: Gemba Walk time:

Gemba Walk Leader:

Gemba Walk Team:

Identified Wastes / Variances

Action Responsible Deadline

1.

2.

3.

4.

5.

6.

7.

8.

5S+2 Maturity Score

Level Level
1. Sort 4. Standardize

2. Set in order 5. Sustain

3. Shine 6. Safety

Total
7. Sustainability (Average)