MONITORING AND EVALUATION SHEET FOR THE PROGRESS OF

5S-KAIZEN ACTIVITIES
Date:
Ver. 2013-February
HOSPITAL: DEPARTMENT:
AWA

Very well
Poorly
poorly
RD

Fairly
Very

Well
DESCRIPTION
MAR
KS
LEADERSHIP
1 Role & Commitment of Management, Sustainability of 5-S activity, Training Program for Middle Mgt., Setting
up 5-S Committees, 5-S Campaigns.
Commitment, knowledge, Awareness on 5S among
1.1 1 2 3 4 5
Managers and health workers
5S progress meeting, monitoring evaluation
1.2 1 2 3 4 5
conducted by WIT and recorded in minutes
Evidence of trainings conducted for Managers and
1.3 1 2 3 4 5
health workers
TOTAL Full mark 15
Acquired marks / 15 x 100 =
SEIRI – (SORTING) “Sasambua”
2 Clutter free Environment in Premises, Inside Offices, Work Place, etc. Evidence of removal of unwanted items
should be evident all around.
Unwanted items removed from Premises, Offices,
2.1 1 2 3 4 5
Work Places including drawers, cabinets and shelves
2.2 Walls are free of old posters, calendars, pictures 1 2 3 4 5
Notice Boards – Current Notices with removal
2.3 1 2 3 4 5
instructions
Color cording for waste disposal maintained and
2.4 1 2 3 4 5
standards followed
TOTAL Full mark 20
Acquired marks / 20 x 100 =
SEITON – (SETTING / ORGANISATION) “Seti”
3 Ability to find whatever is required with the least possible delay, evidence of eliminating the waste of time
throughout the Institute/Organization.
Photographic evidence of Pre 5-S Implementation and
3.1 1 2 3 4 5
afterwards
Visual Control methods adopted to prevent mix-up of
3.2 1 2 3 4 5
items (files, equipment, tools etc.)
Directional Boards from hospital entrance to all
facilities under your section/departments (office,
3.3 1 2 3 4 5
wards, laboratory etc.) and corridors are clearly
marked
All machines/Rooms/Toilets/Switches/fans regulators
3.4 1 2 3 4 5
etc. have identification labels
All items are arranged according to ‘Can See’, ‘Can
3.5 1 2 3 4 5
Take Out’ & ‘Can Return’ principle
3.6 X-axis, Y-axis alignment is evident everywhere 1 2 3 4 5

1
 TOTAL Full mark 30
Acquired marks / 30 x 100 =
SEISO – (SHINING / CLEANLINESS) “Safisha”
4
The Cleanliness all round the Institution should have been carried out according to the 5-S Concepts.
Floors, Walls, Windows, Toilets, Change Rooms in
4.1 1 2 3 4 5
working order & clean
Cleaning responsibility Maps and Schedules
4.2 1 2 3 4 5
displayed
4.3 Waste bin strategy is implemented 1 2 3 4 5
4.4 Use of adequate cleaning tools is evident 1 2 3 4 5
Storage of cleaning tools – Brooms/Maps/Other
4.5 1 2 3 4 5
equipment
Machines/Equipment/Tools/Furniture at a high level of
4.6 1 2 3 4 5
Cleanliness & maintenance schedules displayed
TOTAL Full mark 30

Acquired marks / 30 x 100 =

SEIKETSU – (STANDARDIZATION) “ Sanifisha”

5 High level of Standardization in all activities carried out in SEIRI, SEITON and SEISO and the evidence of
such standards being practiced all around.
Adopt 5-S procedures & standardized on Check list,
5.1 1 2 3 4 5
Labels Corridors/Isles & Gangways
Standardization of Maintenance/Storage of
5.2 Files/Records / Orderliness in Keeping 1 2 3 4 5
Furniture/Equipment in Offices/Workplaces, etc.
Standardized check lists for common Administrative
5.3 1 2 3 4 5
Procedures in hospital and department
TOTAL Full mark 15
Acquired marks / 15 x 100 =
SHITSUKE – (SUSTAIN / SELF DISCIPLINE) “Shikilia”
6 Evidence of an disciplined approach to all 5-S activities through proper Training & Development, which shows
the sustainability in the long term.
Evidence of regular training program for all categories
6.1 1 2 3 4 5
of Employees in the section
Evidence of WIT Activities & promotion of Kaizen
6.2 1 2 3 4 5
Schemes
6.3 Evidence in carrying out Internal Audits by WIT 1 2 3 4 5
Evidence of Self Discipline among visitors to the
6.4 1 2 3 4 5
Institution
6.5 Evidence of Self-Discipline in the overall Institution 1 2 3 4 5
TOTAL Full mark 25
Acquired marks / 25 x 100 =
GRAND TOTAL for 5S activities Full mark 135

2
 Productivity/Services
7
Measures how efficiently inputs to Output are used to produce goods & services with better management
techniques and work methods.
Evidence of methods & systems adopted to improve
7.1 1 2 3 4 5
productivity/employee
Efficiency and effectiveness, use of innovative method
7.2 1 2 3 4 5
to increase and sustain productivity
Evidence in the use of 5S Process to increase
7.3 1 2 3 4 5
Productivity
TOTAL Full mark15
Acquired marks / 15 x 100 =
Quality
8 Goal is to create satisfied customers by doing 100% right work, responding speedily to requirements every
time thus gaining trust & confidence.
Communication plans are evident for Implementation
8.1 1 2 3 4 5
of Quality Improvement
Evidence of fewer rejects, less wastage, less rework
8.2 1 2 3 4 5
through 5S Process
The Quality in the Process of the Manufacture/Service
8.3 1 2 3 4 5
by 5S implementation
TOTAL Full mark 15
Acquired marks / 15 x 100 =
Cost
9 The intrinsic cost of providing products/services to declared standards by a given specified process right first
time and every time
Evidence in reduction in cost of materials, Labor,
9.1 Energy, Overheads lowering of defects etc. by 1 2 3 4 5
introducing 5S concept
Tangible cost advantages through 5S methods in
9.2 1 2 3 4 5
waste control
Evidence of lowering Inventory Cost by the use of 5S
9.3 1 2 3 4 5
Methods
TOTAL Full mark 15
Acquired marks / 15 x 100 =
Safety
10
The overall safety to Employees, Visitors and Property is evidently displayed by the use of 5S Process
Evidence of the effect of safety measured by less
10.1 1 2 3 4 5
accidents occurred in the year
Methods applied in Machinery & Equipment on safety
10.2 1 2 3 4 5
measures
Methods applied to protect the Employees/Visitors on
10.3 1 2 3 4 5
accident
Evidence of Safety Measures applied in providing an
10.4 1 2 3 4 5
excellent health service
10.5 Evidence knowledge and skills of employee on safety 1 2 3 4 5
TOTAL Full mark 25
Acquired marks / 25 x 100 =

3
 Delivery
11
Evidence in the reduction of the delivery time of the Product/Service by the implementation of 5S Process

11.1 Evidence of timely delivery of Products/Services 1 2 3 4 5

Overall effect to health facility by reducing delivery
11.2 1 2 3 4 5
time
Evidence of employee participation to reduce the
11.3 1 2 3 4 5
delivery time
11.4 Evidence of Just In Time in the hospital 1 2 3 4 5
TOTAL Full mark 20
Acquired marks / 20 x 100 =
Morale
12
Evidence in the overall Institution/Organization in improving the Morale by the implementation of 5S Process

12.1 Level of morale displayed by Managers & Workers 1 2 3 4 5

Evidence of projects carried out by the employees to
12.2 1 2 3 4 5
display high level of Morale
12.3 Evidence of 5S - KAIZEN mindset or TQM culture 1 2 3 4 5
TOTAL Full mark 15
Acquired marks / 15 x 100 =
5S Organization, Work Improvement Team (WIT)
13
Role &Activities of WIT,
13.1 Member of WIT are actively working 1 2 3 4 5
13.2 WIT's activities are carried out according schedule 1 2 3 4 5
13.3 Evidence of regular WIT and QIT meeting 1 2 3 4 5
TOTAL Full mark 15
Acquired marks / 15 x 100 =
Empowerment of hospital staff through 5S, KAIZEN, TQM
14
Opportunity and environment for empowerment for hospital staff by themselves
Evidence of learning opportunity for 5S, KAIZEN,
14.1 1 2 3 4 5
TQM
Seminar and Training on 5S-KAIZEN-TQM are
14.2 1 2 3 4 5
conducted for WIT members
TOTAL Full mark 10
Acquired marks / 10 x 100 =
GRAND TOTAL for KAIZEN activities Full mark 130
GRAND TOTAL for section 1 - 14 Full mark 265