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  A B C D E F G H I J K L M N O
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3 1.0 PROBLEM IDENTIFIED BY: (Name/Shift/Dept) AREA / LINE : DATE : My Case Number
4 TEAM : LEAD : Quality Representative
5 GO SEE 1.1. Describe the Problem 1.2. What does success look like? (e.g less stops, less rejects etc)
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9  1.3. Process Flow (How : Go to GEMBA and Draw/Sketch the Flow/Machine/Process, and highlight the problem area(s)
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11 1.4. Focus in on the Problem (Why : To consider all aspects of the problem. Remember data and facts only!)
12 WHEN did the problem start? (e.g after maintence, changover, new material) WHAT is happening?
13 On WHICH material/product format does the problem occur? HOW often does it happen? Is there a pattern?
14 1.5 FOCUSED PROBLEM STATEMENT
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16 1.6 HAS ANYTHING CHANGED? (E.G. MATERTIAL, BATCH, COMPONENT, PEOPLE)
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18 1.7 Check Conditions, Standards and Procedures AT GEMBA
19 Standards Present Adequate Followed Actions
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26 1.8 Five Why Analysis AT GEMBA
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38 Has the problem been resolved? Y = move to "DO" part of this form N = move to "THINK" part of this form

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  A B C D E F G H I J K L M N O U V
1 THINK 2.0 Fishbone 1. Go to GEMBA. 2. Brainstorm main possible causes and verify if they have an impact 3. Group and highlight main causes.    
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24 2.1. Root Cause Actions    
25 Possible Causes Actions Who When    
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36   DO 3.0. What was the Root Cause?    
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38  3.1. Results achieved? How : Check The Impact on The Measure (Has The Problem Been Resolved? What is your evidence?)    
39 Improvement of results (The measure before was… the measure now is…)    
40 Can we apply this to similar machines/process ?   Owner Date    
41 3.2. Standards Created or Updated?    
42 Task Routine    
43 CIL/Cleaning Standard Yes No    
44 Centerlining Yes No    
45 Standard Maintenace Procedure-SMP Yes No    
46 Change Over Standard Yes No    
47 Visual Standard Yes No    
48 Material Spec Yes No    
49 SOP Yes No    
50 Other (Specify) Yes No    
51 3.3. Actions To Eliminate Reoccurrance & Replicate Owner MOC Date    
52 Yes/No    
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54 Yes/No    
55 Yes/No    
56 3.4 Knowledge Share Detail Owner Date    
57 Has an OPL been created Yes No                  
58 Shift Manager to CONFIRM Sign ..................................... Area Manager to CONFIRM Sign ..................................... Date ................    

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