In 2012 I submitted a cleaning checklist for the Foothills Hospital Ambulance Bay. There still isn't one being used.

1. Initial Workspace Check: Sharpe/Devlin
DATE:
SORT SHINE STANDARDIZE SUSTAIN
0 0 0 0
0 0 0 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
3
PASS
1)
2)
3)
4)
5)
6)
7)
8)
9)
Form # : 5S-001
Issued by: EMS
Issued Date: 10/10/2012
REV# :original
Work Center/Dept.: AHS EMS Buildings
Revision Date: 12/12/2012
FMC Ambulance Bay
5S AUDIT CHECKLIST
CONTINUOUS IMPROVEMENT DEPARTMENT
# of Questions
Average Score
SET IN ORDER
0
0
AREA:
Total Score
0
Procedures are established to identify unnecessary items: Are there any FMC hospital
items that need to be disposed of or relocated to another area?
4
FAILURE PASS
Unnecessary / misplaced equipment or supplies exist: Are there any Dangerous or
useless items (BioHazard, recycling, linen) on shelves or in work / storage areas?
SORT ACTIVITY DESCRIPTIONS
FAILURE
Unneeded items on walls, cabinets / bulletin boards: Do walls, cabinets or boards have
unnecessary or outdated signage / posters?
Patient pathways, supply corridors and corners free of clutter and trip hazards: Is there
any garbage, supplies or equipment lying about on the floor?
Ambulance Bay windows, shelves and surfaces regularly cleaned and disinfected: Are
Bay and Duty Room Shine Stations fully equipped and being used?
SCORE
Overstock of supplies, parts, or materials cannot exist: Are drawers / cabinets / work
surfaces / storage areas appropriately filled?
SCORESHINE ACTIVITY DESCRIPTIONS
Battery chargers, Microwave, work surfaces and PCR writing area are clean: Are
counters, floors, carpets, cabinets and walls clean? Does paintwork need re-doing?
0
0
TOTAL
#DIV/0!#DIV/0!
PASS
1
SCORING GUIDELINES
2
Garbage and recyclables are collected and disposed of correctly: Are wastebaskets
and destroyer bins regularly emptied before they overflow?
Floors are as dry as possible and clear of debris in all weather: Are floor drains clear?
Do the need to be swept? Is the shop-vac being used?

2. Initial Workspace Check: Sharpe/Devlin
DATE:
SORT SHINE STANDARDIZE SUSTAIN
0 0 0 0
0 0 0 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
3
PASS
Form # : 5S-001
Issued by: EMS
Issued Date: 10/10/2012
REV# :original
Work Center/Dept.: AHS EMS Buildings
Revision Date: 12/12/2012
FMC Ambulance Bay
5S AUDIT CHECKLIST
CONTINUOUS IMPROVEMENT DEPARTMENT
# of Questions
Average Score
SET IN ORDER
0
0
AREA:
Total Score
0 4
FAILURE PASS
SORT ACTIVITY DESCRIPTIONS
FAILURE
SCORE
0
0
TOTAL
#DIV/0!#DIV/0!
PASS
1
SCORING GUIDELINES
2
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
5S Scoring Guidelines
5S audits occur regularly: Have dates been set within the team for audits?
5S Action Plan and Team member area of responsibility are current: Are activity
scheduling, departments tasks and performance indicators clear and visualized?
Standardized cleaning and work procedures are followed.
SET IN ORDER ACTIVITY DESCRIPTIONS
All items have a specific location : Are supplies, equipment, materials and documents
well-ordered and easy to reach / return to their location?
Equipment locations, lockers and trolleys are identified: Are all the various storage and
staging areas, cabinets and trolleys clearly labelled?
Public Relations / Supervisor / HSAA cabinets clearly marked: Is there clear labelling in
these spaces with instructions for use and resupply?
Medical resupply drawers, cabinets, shelving, Pyxis and storage areas are clearly
labeled and well organized: Are shelves, drawers and cabinets identified with labels,
markings and visible codes? Are these supplies properly secured?
SCORE
The area standard for Sort, Set in order and Shine is defined, accessible and
communicated to each team member
STANDARDIZE ACTIVITY DESCRIPTIONS
Files and equipment have a printed label (Recommended) or clear hand written
identification and are consistent throughout the area (same type of label and font used
for all the files and/or equipments)
Specific cleaning and organizing tasks have been developed and assigned for the work
area
Staff is trained and fully understands 5S procedures
SCORE
Visual management tools identify if work is complete.
Everyone is involved in the improvement activities : Do team members carry out
regular meetings in a specific area?
SUSTAIN ACTIVITY DESCRIPTIONS
SCORE
All items are placed in the proper location: Is the title, phone number and name of
person in charge on all platforms, lockers, cabinets and resupply trolleys?

3. Initial Workspace Check: Sharpe/Devlin
DATE:
SORT SHINE STANDARDIZE SUSTAIN
0 0 0 0
0 0 0 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
3
PASS
Form # : 5S-001
Issued by: EMS
Issued Date: 10/10/2012
REV# :original
Work Center/Dept.: AHS EMS Buildings
Revision Date: 12/12/2012
FMC Ambulance Bay
5S AUDIT CHECKLIST
CONTINUOUS IMPROVEMENT DEPARTMENT
# of Questions
Average Score
SET IN ORDER
0
0
AREA:
Total Score
0 4
FAILURE PASS
SORT ACTIVITY DESCRIPTIONS
FAILURE
SCORE
0
0
TOTAL
#DIV/0!#DIV/0!
PASS
1
SCORING GUIDELINES
2
SCORING SYSTEM
Scale / # Problems
High - 5 or more
Rating / Score
0
Category AREAS FOR IMPROVEMENT
Low - None
3-4 1
DATE
2
31
4
2