Simple Kaizen Submission Name: Dept: Date:

My Idea

After Improvement: Write your idea! _________________________________________________________

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Before Improvement: What is the Present Issue or Problem? _______________________________

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Circle one: Implemented Not Approved On Hold

Comment:__________________________________________________

Supervisor’s Signature: ____________________________ Date: ______

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Assigned To:________________________________________________

Results: How did it make your job better? ________________________________________________________

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