5S CQI GQA Checklist
5S CQI GQA Checklist
5S CQI GQA Checklist
CQI
GQA CHECKLIST:MOH/QASD/5S-CQI/03
Date:
Name of the Department/Unit ………………………………………….
Name & Designation of the HOD/In-charge ………………………………
SN Rating Level Rating Criteria Scores
1 Rating level 0: L0 5 or more problems exist 0 Note: Any question not applicable
2 Rating level 1:L1 3 or 4 problem exist 1 for the Unit/Dept. shall be marked
3 Rating level 2:L2 2 problem exist 2 as ‘NA’ and ignore the irrelevant
points by not counting them in the
4 Rating level 3:L3 1 problem exist 3
final score calculation.
5 Rating level: L4 0 problem 4
6 Rating Level: L5 Not applicable NA
Rating level
SN GQA indicators 0 1 2 3 4 5 Remarks
A: General
I: Laundry
1 Floor, wall, ceiling and rooms are free of dust
and unwanted items.
2 Tops and insides of all cupboards, shelves,
tables, and corners are free of unwanted items.
3 Worn out linens and other old machinery parts
removed from the unit.
4 Disinfection procedures followed as per the
infection control guidelines.
II: Kitchen
GQA CHECKLIST:MOH/QASD/5S-CQI/03
11 Proper shade (garage) for each ambulance.
12 Proper history book maintained (updated).
13 Orderliness and cleanliness inside/outside.
IV: General administration
I: SORT
GQA CHECKLIST:MOH/QASD/5S-CQI/03
III: SHINE
1. ……………………………………………….
2. ……………………………………………….
3. ……………………………………………….
GQA CHECKLIST:MOH/QASD/5S-CQI/03
GQA checklist developed by: Changlo, SN, Trashigang Hospita land Krishna Mongar, Punakha hospital
Verified and adopted by: QASD technical working team, MoH.
Abbreviation: PPE-Personal protective equipment, SOP-Standard Operating Procedure,
5S-CQI- Sort, Set, Shine, Standardise and Sustain Continuous Quality Improvement.
References:
● Miller, J., 2021. 101 Kaizen Templates: Workplace 5S Audit Sheet | Gemba Academy. [online] Gemba
Academy. Available at:
<https://blog.gembaacademy.com/2008/03/19/101_kaizen_templates_workplace_5s_audit_sheet/>
[Accessed 18 May 2021].
● 2013. 5S Implementation Guidelines in Uganda. 1st ed. [ebook] Uganda: Ministry of health, pp.1-49.
Available at: <https://www.jica.go.jp/english/our_work/thematic_issues/health/c8h0vm00009u4yt7-
att/case_materials_uganda_02.pdf> [Accessed 18 May 2021].