5S Observation Report Form
Complete this form to document your workplace 5S audit and report findings for continuous improvement.
Observer Name
*
First Name
Last Name
Observation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department / Area Observed
*
5S Category Assessment
*
Rows
Rating (1-5)
Comments
Sort (Seiri)
1
Set in Order (Seiton)
2
Shine (Seiso)
3
Standardize (Seiketsu)
4
Sustain (Shitsuke)
5
Overall 5S Rating
*
1
2
3
4
5
Positive Observations / Strengths Noted
Issues Found / Areas for Improvement
Corrective Actions Required
Responsible Person for Corrective Action
First Name
Last Name
Target Date for Corrective Action Completion
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Follow-up Required?
*
Yes
No
Additional Comments / Notes
Submit Report
Should be Empty: