Problem ____________________________________ ____________________________________________

1. Problem ____________________________________ ____________________________________________ ____________________________________________ Idea ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Date Originated __________ By: ________________ Expected Benefits _____________________________ ____________________________________________ Input Needed From ___________________________ ____________________________________________ Problem ____________________________________ ____________________________________________ ____________________________________________ Idea ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Date Originated __________ By: ________________ Expected Benefits _____________________________ ____________________________________________ Input Needed From ___________________________ ____________________________________________ www.HCKaizen.com www.HCKaizen.com Problem ____________________________________ ____________________________________________ ____________________________________________ Idea ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Date Originated __________ By: ________________ Expected Benefits _____________________________ ____________________________________________ Input Needed From ___________________________ ____________________________________________ Problem ____________________________________ ____________________________________________ ____________________________________________ Idea ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Date Originated __________ By: ________________ Expected Benefits _____________________________ ____________________________________________ Input Needed From ___________________________ ____________________________________________ www.HCKaizen.com www.HCKaizen.com

2. Implementation Steps ______________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Results Verified? YES / NO New Method Standardized? YES / NO Completed Date _____________________ Implementation Steps ______________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Results Verified? YES / NO New Method Standardized? YES / NO Completed Date _____________________ Implementation Steps ______________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Results Verified? YES / NO New Method Standardized? YES / NO Completed Date _____________________ Implementation Steps ______________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Results Verified? YES / NO New Method Standardized? YES / NO Completed Date _____________________