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AM/3.0/6SACL/VER2.O
01-APRIL-2013
ENERGY SERVICE
Activity
SORT
(
Score
Systematic
Arrangement
(
SHINE
( )
Prepared by
Management Representative
Approved By
Asset Management Head
QUIPPO
AM/3.0/6SACL/VER2.O
01-APRIL-2013
ENERGY SERVICE
Sustain
( )
Safety
(
)
Prepared by
Management Representative
Approved By
Asset Management Head
QUIPPO
AM/3.0/6SACL/VER2.O
01-APRIL-2013
ENERGY SERVICE
Score
Attribute
1
Non
Compliant
1.1 - 2
Least
Compliant
2.1 - 3
Meeting a
reasonable
level of
Compliance
3.1 - 4
Meeting most
of Compliance
4.1 - 5
Fully
Compliant
Notes:
1. Audit is done once in two month by Asset Manager. Site Operator / In charge is responsible
for 6S.Copy is sent to QA/QC every two months.
2. This is self assessment. Give scores to each box. 5 means 100% compliant and 1 means
non compliance. Add all scores and divide this by 20 to get Current score of site.
Name:
Name:
Signature:
Signature:
(Asset Manager)
Prepared by
Management Representative
(Customer)
Approved By
Asset Management Head