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Root Cause Template

Root Cause Template

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Published by smufiroz

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Published by: smufiroz on Jul 04, 2012
Copyright:Attribution Non-commercial

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09/20/2014

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Root Cause Analysis
Page 1 of 5Date:RCA Initiated by:Investigator:
1.Define the problem
Describe the incident. What was defect, how many, how often, etc.
Step (not all required, depending on problem)
D
1 Define the problem2. Map Process (if required)
M
3. Gather data4. Cause/Effect Analysis (Seeking Root Cause)
A
5. Verifying root cause with data6. Solutions & Prevention steps development
(including cost/benefit)
I
7. Pilot of implementation8. Implementation
C
9. Control/Monitoring Plan (including Process Metrics)10. Lessons Learned
Do in Visio, then copy to here. Keep Visio page rectangular no more than 7.5 inches wide.
Sample
rocess ncent nvestgaton
Page 2 of 5Date completedThis form is a tool for finding causes of process problems and developing actions for eliminating,preventing, and minimizing future problems.Incident Date:
2.Process Map
 
RememberDo in Visio, then copy to here. Keep Visio shape rectanular no more than 7.5 inches wide.
Cloud potentialroot causes
Root Cause Investigation
Page 3 of 5
6.Recommended Solutions
Double-click on template and enter data with Visio
Approval needed by:
4. Cause/Effect Diagram
5. Verifying root cause with data
 
Pro osed 
Put Problem Here
SAMPLE
 
Scale: 1-None 2-Somewhat 3-Moderate 4-Very 5-Extreme
Cost BenefitAnnualized cost of problem
1$0.00
Percent of problem reduction
20%
Cost of proposed solution
3$0.00
Total first year savings (1 x 2 - 3)
$0.00
7- 8. Action plan for implementation
Who, what , when, where and how
If FMEA needed go to FMEA tab
Root Cause Resolution
Page 4 of 5
9. Control Plan (include process metrics)
 
oot ause
SolutionsPractical Methods Effectiveness Feasibility Cost Benefit Overall Action

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