Poka-Yoke Checklist Form
Complete this checklist to verify Poka-Yoke error-proofing steps for your process. Ensure each step is reviewed and confirmed for quality assurance.
Process Name
*
Process Step or Checkpoint
*
Responsible Person
*
Date of Checklist Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Step Status
*
Completed
Not Completed
Not Applicable
Was an Error Detected?
*
No
Yes
Type of Error (if any)
Please Select
None
Assembly Error
Material Error
Process Sequence Error
Omission
Other
Corrective Action Taken
Additional Comments or Notes
Attach Supporting Evidence (photo, document, etc.)
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