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    20 views6 pages

    FMEA (MRMA) Reporting Sheet

    Uploaded by

    prst_08

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 6

    Failure Mode and Effect Analysis - Tracking and Reporting Form

    Seni
    Functions Failure Modes Effects Contributory Factors
    or

    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    21
    22
    23
    24
    25

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 1 of 6
    www.Sentinel-Event.com for non-commercial purposes
    Failure Mode and Effect Analysis - Tracking and Reporting Form

    The following is offered as a sample of one way to code different FMEA elements for eaier communication and tracking.

    Item
    Functions Failure Modes Effects Contributory Factors
    No.

    1 The Functions identified in the The first Failure Mode for the first (E001.1.1) The same structure should be
    flowchart or process analysis Function would go here. used throughout the reporting
    should be placed here, in (FM001.1) table. (CF001.1.1.1)
    sequence. Thus, the first
    This would be the second
    Function would go here. Our
    Contributory Factor (or
    recommendation is that each
    Contributor) for Effect E001a1.
    Function be listed only once, no
    (CF001.1.1.2)
    matter how many Failure Modes
    2 there might be for a given Since there may well be more (E001.2.1) Recall that a given Effect may
    Function. Note that we have than one Failure Mode for any have several Contributory
    identified (coded) every FMEA given Function, an easy-to-read Factors. (CF001.2.1.1)
    element for easy reference. This layout must be used. (FM001.2)
    is optional, and if done, any
    coding or identificaiton method
    3 may be used. (F001) And the third Failure Mode for (E001.3.1) (CF001.3.1.1)
    this given Function would go
    here, etc. (FM001.3)
    4 The second Function would go Failure Mode (FM002.1) (E002.1.1) (CF002.1.1.1)
    here. (F002)
    5 The third Function goes here. Failure Mode (FM003.1) (E003.1.1) (CF003.1.1.1)
    6 (F003) Failure Mode (FM003.2) (E003.2.1) (CF003.1.1.2)
    7 Etc…

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 2 of 6
    www.Sentinel-Event.com for non-commercial purposes
    Failure Mode and Effect Analysis - Tracking and Reporting Form

    Concurrence
    Management
    Occurrence

    Criticality
    Detection
    Severity
    Responsible

    Senior
    Action Taken

    RPN
    Current Controls Recommended Action Party &
    & Date
    Target Date

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 3 of 6
    www.Sentinel-Event.com for non-commercial purposes
    Failure Mode and Effect Analysis - Tracking and Reporting Form

    Concurrence
    Management
    Occurrence

    Criticality
    Detection
    Severity
    Responsible

    Senior
    Action Taken

    RPN
    Current Controls Recommended Action Party &
    & Date
    Target Date

    (RA001.1.1.1.1.1)

    (CC001.1.1.2.1) (RA001.1.1.1.2.1)

    (RA001.2.1.1.1.1)

    (CC001.3.1.2.1)

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 4 of 6
    www.Sentinel-Event.com for non-commercial purposes
    Failure Mode and Effect Analysis - Tracking and Reporting Form

    Occurrence

    Criticality
    Detection
    Severity
    Responsible

    RPN
    Evaluation Method
    Party & Date

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 5 of 6
    www.Sentinel-Event.com for non-commercial purposes
    Failure Mode and Effect Analysis - Tracking and Reporting Form

    Occurrence

    Criticality
    Detection
    Severity
    Responsible

    RPN
    Evaluation Method
    Party & Date

    Copyright 2002 by Medical Risk Management Associates, LLC May be used with proper credit
    Page 6 of 6
    www.Sentinel-Event.com for non-commercial purposes

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