7 6S SELF ASSESMENT FORM

ZONE NAME ZONE AREA CHAMPION NAME

ORBIT COMMERCIAL DEPARTMENT Y. PRASAD RAO
RATING LEVEL RATING CRITERIA Jan-18 Feb-18
9 TO 10 NO GAPS OBSERVED , WORLD CLASS IMPLEMENTATION AUDITOR NAME AUDITOR NAME
8 TO 9 ≤ 2 NON CONFORMENCES / IMPROVEMENTS

6 TO 8 > 2 BUT≤ 4 NON CONFORMENCES / IMPROVEMENTS

4 TO 6 > 4 BUT ≤ 6 NON CONFORMENCES / IMPROVEMENTS

2 TO 4 > 6 BUT≤ 8 NON CONFORMENCES / IMPROVEMENTS

1 TO 2 > 8 NON CONFORMANCES / IMPROVEMENTS AUDITOR SIGNATURE AUDITOR SIGNATURE

SELF ASSESSMENT STATUS AUDIT STATUS
Jan-18 Feb-18 Mar-18 Jan-18 Feb-18

SUBMISSION DATE SUBMISSION DATE SUBMISSION DATE AUDIT DATE : AUDIT DATE :

CHAMPION
SIGNATURE CHAMPION SIGNATURE CHAMPION SIGNATURE AUDITOR SIGNATURE AUDITOR SIGNATUR

CHAMPION SIGNATURE CHAMPION SIGNATUR

HOD HOD 433548413.xlsx

HOD
 HOD HOD HOD HOD SIGNATURE HOD SIGNATURE
VERFICATION STATUS BY IMS DEPARTMENT ( SELF ASSESSMENT SUBMISSION STAGE ) VERIFICATION BY IMS DEPARTMENT ( AU

DATE DATE DATE DATE SIGN DATE

SIGN SIGN SIGN HOD SIGNATURE HOD SIGNATURE

433548413.xlsx
 6S 4S 1S
1S

3S 2S
2S
5S
Mar-18
ME AUDITOR NAME

URE AUDITOR SIGNATURE

ATUS
eb-18 Mar-18

AUDIT DATE:

R SIGNATURE AUDITOR SIGNATURE

N SIGNATURE CHAMPION SIGNATURE

433548413.xlsx
IGNATURE CHAMPION SIGNATURE
MENT ( AUDIT STAGE )

SIGN DATE SIGN

IGNATURE CHAMPION SIGNATURE

433548413.xlsx
 7 6S SELF ASSESMENT FORM

ZONE NAME
ORBIT

5S No. CHECKING ITEM EVALUATION CRITERIA

SELF

ACCUMALATION OF UNWANTED / UNUSED FILES / PAPERS / SCRAP ITEMS ARE NOT EVIDENT IN STORAGE RACKS, COMMON
AREA'S & NO MAN ZONES ( RATING OUT OF10 )

ACCUMALATION OF UNWANTED / UNUSED FILES / PAPERS / SCRAP ITEMS ARE NOT EVIDENT THROUGHOUT THE HOD CABINS,
INCLUDING PERSONNEL RACKS ( RATING OUT OF 10 )
1 S = SORTING

FILE CABINETS / PERSONAL ACCUMALATION OF UNWANTED / UNUSED FILES / PAPERS / SCRAP ITEMS ARE NOT EVIDENT THROUGHOUT EMPLOYEE
1 LOCKERS / TABLES / COMMON INDIVIDUAL WORK STATIONS,
AREAS/ NO MAN ZONES
ALL THE WALLS / NOTICE BOARDS ARE FREE FROM IRRELEVANT DISPLAYS ( RATING OUT OF 10 )

OBSELE DOCUMENTS (OLD DOCUMENTS, NOT WORIKING EQUIPMENTS ARE NOT EVIDENCED IN WORK PLACE ( RATING OUT OF
10 )
PERIODICAL DISPOSING OF OLD DOCUMENTS ARE EVIDENCED (CHECK FOR MAIL, IOM ETC) FOR EVIDENCE ( RATING OUT OF
10 )
a) ALL THE FILE CABINETS , STORING AREAS ARE IDENTIFIED & LABELED
b) LIST OF FILES AVAILABLE IN RACKS AND STORAGE PLACES ARE PREPARED AND DISPLAYED
c) ALL THE ITEMS ARE AVAILABLE AT THIER SPECIFIC LOCATIONS MARKED LIKE WATER DISPENCER, NOT IN USE
ITEMS ETC
d) IT IS EASY TO FIND ANY ITEM / DOCUMENT WITHOUT DELAY (MAX 30 SECONDS TO 1 MINUTE) (RUNNING DOCUMENTS
& OLD DOCUMENTS IN ANY RACKS / STORAGE CABINS )
IDENTIFICATION AND
e) AREA DESIGNATED FOR RED TAG ( PLACE WHERE UNUSED FILES/ ITEMS TO BE KEPT )
TRACEABILITY
f) PULL/ PUSH FOR DOORS ARE IN PLACE
g) ALL LIGHTS , FANS , AC'S , SWITCHES ARE IDENTIFIED AND EASY TO TRACE
MATIZING (SET IN ORDER)

h) ASSET CODE EVIDENCED FOR ALL ITEMS LIKE AC , FAN,

FURNITURE, IT EQUIPMENTS (PRINTER/LAPTOP/ DESKTOP/ CPU ) , PHONE ETC ( RATING OUT OF 10 )

WHERE ABOUTS OF STAFF STATUS OF EMPLOYEE ON DUTY / LEAVE IS DISPLAYED (DISPLAY BY PRINT / WRITING ETC) ( RATING OUT OF 10 )
2
2S = SYSTEMATIZING (SET IN ORDER)
7 6S SELF ASSESMENT FORM

ZONE NAME
2 ORBIT
a) STAFF NAMES ARE DISPLAYED AT INDIVIDUAL DESK
b) UPDATED LIST OF PHONE NOS DISPLAY AT RESPECTIVE STAGE
c) FLOOR MAPS AVAILABLE FOR EASY IDENTIFICATION & TRACEABILITY FOR DEPARTMENT & PERSONS ( RATING OUT OF 10 )

RETENTION PERIOD OF PROJECT DOCUMENTS ARE ESTABLISHED AND AWARENESS AMONG WITH THE TEAM ( RATING OUT OF
10 )

GENERAL RETENTION PERIOD OF GENERAL DOCUMENTS ARE ESTABLISHED AND AWARENESS AMONG WITH THE TEAM ( RATING OUT OF 10
)

REFERENCE DOCUMENTS ESTABLISHING RETENTION PERIOD TO BE ESTABLISHED WHERE EVER REQUIRED

METHOD FOR DISPOSAL OF SCRAP DOCUMENTS IS, DEFINED AND MADE AWARE TO ALL TEAM

DO'S AND DONT'S ARE DISPLAYED FOR GENERAL AWARENESS ON 5S & SAFETY (RATING OUT OF10)
a) INDIVIDUAL WORK STATIONS, HOD CABINS & NO MAN ZONES ARE KEPT NEAT AND CLEAN INCLUDING TABLE , CHAIR
SHINE ( CLEANINESS)

, LAPTOP, DESKTOP, CPU, PHONE ETC

b) FLOORS , WINDOWS, WINDOW GLASSES, DOORS ARE KEPT NEAT AND CLEAN
c)COMMON FILE CABINETS ( INSIDE& OUTSIDE) , COMMON AREAS , NO MAN ZONES ARE KEPT NEAT AND CLEAN
CLEANING IS A METHOD OF
d) GARBAGE BINS FOUND TO BE
3 INSPECTION, LOOK FOR
KEPT NEAT AND CLEAN e) COMMON UTILITIES LIKE FANS , A/C'S , LIGHTS DOMES ARE KEPT NEAT AND CLEAN (
HIDDEN DEFECTS
RATING OUT OF 10 )

a) PROPER HOUSE KEEPING CHECK LISTS WITH ACTIVITIES (DAILY, WEEKLY &MONTHLY) & COMPLETION STATUS IS MAINTAINED
& DISPLAYED b) TIMELY ESCALATION FOR ADMIN SERVICES ARE EVDIENCED ( RATING OUT OF 10 )

ARE THE FIRST 3S (SORT, SET IN ORDER, SHINE) BEING MAINTAINED? REGULARLY ( RATING OUT OF 10 )
ARE ALL NECESSARY SIGNAGES AND INFORMATION PERTAINING TO THE ZONE AREA VISIBLE AND STANDARDIZED?
(LIKE FLOOR MAPS, RED TAG AREA, HOUSEKEEPING CHECK LISTS (WITH RELEVANT PHOTOS DISPLAY IN CHECK
STANDARDISATION

LIST), ,DO'S & DON’T'S & PRECAUTIONS ETC ( RATING OUT OF 10 )

PRACTICES OF 1S,2S & 3S,
CONTINUES IMPROVEMENT & STANDARDISATION FOR EACH WORK STATION, HOD CABINS,& NO MAN ZONES (ABOUT DISPLAY ON NOTICE BOARDS,
4
STANDARDISATION OF PERSONNEL DESKS, ETC ( RATING OUT OF 10 )
VISUAL CONTROL
ARE ALL VISUAL DISPLAYS CURRENT AND UPDATE ACROSS THE ZONE? ( RATING OUT OF 10 )
STANDARDISATION
7 6S SELF ASSESMENT FORM
PRACTICES OF 1S,2S & 3S,
CONTINUES IMPROVEMENT &
4
STANDARDISATION OF ZONE NAME
VISUAL CONTROL
ORBIT
ON TIME FILING OF DOCUMENTS/RECORDS AND KEEPING OF INCOMING & OUTGOING TRAYSS INDIVIDUAL WORK STATIONS &
HOD CABINS. ( RATING OUT OF 10 )

SUBMISSION OF 5S ASSESSMENTS BEFORE 5th OF EVERY MONTH ( RATING OUT OF 10 )

SUBMISSION OF SELF
ASSESSMENT & AUIDTS AUDIT COMPLETION BEFORE 15TH ( RATING OUT OF 10 )
SUSTAIN

AUDIT REPORT SUBMISSION ,

SUBMISSION OF AUIDT SUGGESTION CUM COMPLIANCE REPORT BY 22ND OF EVERY MONTH ( RATING OUT OF 10 )
5 POST AUDIT , AUDIT
RATING AWARENESS BY TEAM
a ) DISPLAY OF MONTHLY AUDIT SCORE IS EVIDENCED b) TEAM MEMBERS ARE AWARE ABOUT 5S PRACTICES
c) EVIDENCE FOR TIMELY ESCALATION TO IMS TEAM ON CONDUCTING 5S
AWARENESS
AWARENESS PROGRAM
( RATING OUT OF 10 )

FIRE EXTINGUISHERS ARE EASILY ACCESSIBLEEXPIRY DATES ARE CLEARLY MARKED ( RATING OUT OF 10 )

AISLES, DOORWAYS, DOOR WAYS AND CORNERS FREE FROM OBSTRUCTIONS TO PERMIT VISIBILITY AND MOVEMENT
( RATING OUT OF 10 )

LIGHTING IN WORK AREAS AND WALK WAYS ARE ADEQUATE? ( RATING OUT OF 10 )

CHAIRS IN SAFE CONDITION AND CASTER, RUNGSAND LEGS ARE GOOD CONDITION ( RATING OUT OF 10 )
SAFETY

IS THE FLOOR SURFACE LEVEL FREE FROM DAMAGE? ( RATING OUT OF 10 )

6 SAFETY (ZERO INCIDENTS)
FLOOR CONDITION IS FREE FROM T WET OR SLIPPARY? ( RATING OUT OF 10 )

ACCESS TO ELECTRICAL MCB PANELS UNOBSTRUCTION ( RATING OUT OF 10 )

ELECTRICAL CORDS AND PLUGS ARE IN GOOD CONDITION (i.e. FREE FROM DAMAGE AND JOINTS) ( RATING OUT OF
10 )

ALL WINDOWS,DOORS AND LOCKS ARE IN GOOD CONDITION (i.e. FREE FROM DAMAGE) ( RATING OUT OF 10 )
ALL THE TEAM MEMBERS ARE AWARE ABOUT SAFETY PRACTICES ( RATING OUT OF 10 )

NOTES TO CHAMIPONS & AUDITORS : SCORE

 7 6S SELF ASSESMENT FORM

ZONE NAME
ORBIT
1. SELF ASSESSMENT SUBMISSION DATE : BY 5TH OF EVERY MONTH. "0" MARKS WILL BE AWARDED FOR THE ASSESSMENT SHEET RECEIVED AVG SCO
BEYOND 5TH
2. AUDIT COMPLETION DATE 15TH OF EVERY MONTH : IT IS THE RESPONSIBILITY OF THE CHAMPION TO GET THE AUDIT COMPLETION BEFORE 15TH
% AVG SCO
OF EVERY MONTH . IF THE AUDIT NOT COMPLETED BY 15TH THE RATING WILL BE AWAREDED AS " 0 "
3. CHAMPIONS HAS TO SUBMIT THE AUIDT SHEET ALONG WITH COMPLAINCE REPORT AGAINST THE POINTS GIVEN BY AUDITOR BY 22ND FOR THE
RUNNING MONTH (IF THE COMPLIANCE REPORT NOT RECEIVED BY 20THTHE RATING WILL BE AWAREDED AS " 0 "). THE CHAMPIONS HAS TO GET
VERIFIED THE COMPLIANCES BY THE AUDITOR DURING THE NEXT MONTH AUIDT. INCASE IF THE REMARKS GIVEN BY THE AUIDTOR IS " 3 " AS PER TOTAL SCO
THE AUDIT SUGGESTION CUM COMPLIANCE SHEET, NO MARKS WILL BE AWARDED AGAINST THE SAID CLAUSE.
 5S 4S 1S

CHAMPION NAME 6S 3S 2S
Y. PRASAD RAO
SCORE SCORE SCORE
Nov-17 Dec-17 Oct-17
AUDITO AUDITO
AUDITOR SELF AUDITOR SELF AUDITOR SELF AUDITOR SELF SELF
R R

0 0 0 0 0 0
 5S 4S 1S

CHAMPION NAME 6S 3S 2S
Y. PRASAD RAO

0 0 0 0 0 0

0 0 0 0 0 0
 5S 4S 1S

CHAMPION NAME 6S 3S 2S
Y. PRASAD RAO

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

SCORE 0 0 SCORE 0 0 SCORE 0 0

 5S 4S 1S

CHAMPION NAME 6S 3S 2S
Y. PRASAD RAO
G SCORE 0 0 AVG SCORE 0 0 AVG SCORE 0 0

G SCORE 0 0 % AVG SCORE 0 0 % AVG SCORE 0 0

AL SCORE 0 TOTAL SCORE 0 TOTAL SCORE 0

 AUDIT SUGGESTIONS CUM COMPLIANCE REPORT SHEET NO :

NOTE TO CHAMPION : COMPLIANCE SUBMISSION DATE 22ND OF EVERY MONTH

ZONE NAME : VISWAKARMA ZONE CHAMPION : SATYA VARDHAN RAJU

LOCATION : EPCM ENGINEERING & IT OFFICE

AUDITOR NAME : MONTH :

RISK VERIFICATION BY
RES 5S NO COMMENTS BY AUDITEE DEPARTMENT WITH COMPLETION
(1S/2S/3S) S. NO OBSERVATIONS/IMPROVEMENTS SUGGESTED FACTOR AUDITOR DURING
COMMITTED DATE OF COMPLETION STATUS
(A-B-C-D) NEXT AUIDT

RISK FACTOR : A - FINANCIAL SUPPORT , B - ADMIN INITIATION REQD, C- HOD INITIATION REQUIRED, D- TEAM SUPPORT REQUIRED IMS DEPT COMMENTS
COMPLIANCE STATUS : 1- COMPLETED , 2- NOT COMPLETED , CAN BE AUDITED IN THE NEXT MONTH REPORT RECD DATE :
REMARKS BY AUDITOR DURING NEXT AUDIT: 1- COMPLETED & SATISFACTORY, 2- COMPLETED BUT NOT UPTO THE REQUIRED LEVEL
3- NOT COMPLETED VERIFICATION DURING NEXT AUDIT
Auditor/s AUDITOR
Signature Champion Signature Auditee Dept HOD Signature SIGNATURE IMS DEPT