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Gemba Walk Observation & Coaching Form (Interactive)

An interactive, facilitator-friendly gemba observation and coaching form that captures structured observations, coaching moments, improvement experiments, owners, measurable success criteria, and follow-up dates so gemba becomes coaching-driven improvement rather than a checklist ritual.

Interactive Tool

Gemba Walk Observation & Coaching Form

Use this form during or immediately after a gemba walk to capture what you saw, how you coached, the improvement experiment you agreed on, who owns the follow-up, and how you will measure success. Short, specific entries with clear owners and follow-up dates increase the chance observations become real improvements.

Enter the date of the gemba walk in YYYY-MM-DD format.
Optional: e.g., 09:30
Name of the person leading this observation.
Where the observation was made (machine, station, area).
Who was working or affected during the observation.
Describe briefly and specifically what you observed. Include concrete facts, not assumptions.
What impact did the observation have or could it have? Mention safety, quality, output, rework, or team effects.
Choose how urgent or impactful this observation is.
What did you coach right away? Capture the key coaching question or action. Examples: questions asked, demonstrations, praise.
Select the primary coaching style you used.
Describe the proposed short experiment or change. Keep it small, time-boxed, and measurable where possible.
Name the person or role who will own the follow-up. Ownership is essential for follow-through.
Operational priority relative to other items.
Date to check progress or evaluate the experiment. Leave blank if no follow-up is needed.
What will you check on the follow-up date? Be specific about the observable evidence.
How will you know the experiment worked? Example: reduce defects per batch from X to Y, cut changeover time by Z minutes.
Current state of the action.
Record whether a photo was taken to document the observation. (Link or attachment can be added in attachments field.)
Optional: URLs or references to photos, files, or work orders.
Short note for the leader: what went well in the coaching moment and what you'd try differently next time. Helps develop coaching capability.
If yes and a follow-up date is set, create a reminder for the owner.
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