iRISE/EHSMS/5SA REV#00 EFF DATE:01/04/2021

iRISE INDIA PVT. LTD

MONTHLY 5S AUDIT FORM

DATE: AREA:
S.NO CHECK POINT YES NO Action Taken
1st S =(SORT OUT)
1 Unwanted thing lying on M/c ,table, self-etc.

2 Things are not kept which are not in use.

3 No spare component, tool, files, papers etc. Are lying

unnecessarily.
4 Things which cannot be used are removed.

2nd S (SET IN ORDER)

1 Specified place for keeping component, tool, and files.

2 Everyone is keeping things at decided place.

3 Arrangement of rest room is good

4 The identification system of the entire above is good.

3rd S=(SHINE/CLEANING)
1 Whether there is scrap, dust cobweb, oil spillage in the
room/workplace.
2 Cleaning of machine is good.
3 Whether there is scrap, dust, oil leakage, water leakage.

4 Whether scrap bin dust bin are overflowing.

4th S=(STANDARDIZE)
1 Places for keeping component, tool, gauge and file are specified.

2 Places for keeping component, tools, gauge and files are neat
and tidy.
3 Whether the work area is dirty.

4 Indications are easy to see or not.

5th S= (SUSTAIN)
1 All worker are using required PPE.

2 PPE used are being worn properly.

3 People are smoking/ spitting at workplace.

4 Dust bins for waste material are kept in place.

ANY OTHER
ISSUE(SUGGESTION)…………………………………………………………………………………………………………………………………………………

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NAME & SIGNATURE OF SUPERVISOR: