Customer Name

Production Date

Delivery Date

Problem Definition:
(who,what, when where and how)
3 Legged 5 Why

How problem was created

Problem Description:
Explain why the problem occurred:
Why:
Why:
Why:
Why:(The root cause of non conformance)

Why problem was not detected?

Problem Description:
Explain why the problem was not detected:
Why:
Why:
Why:

Picture of Current State

Why problem w
What is the Systemic root cause?

Why:
Why:
Problem Description:
Explain the Systemic root cause:
Why:
Why:
Why:
Why:

Recurrence and Prevention Statement

Look Across For Prevention:

Within the Occurred Plant

List the name of the core team members (name and title):
Product/Process Name

icture of Current State

Date of Occurrence

Corrective Actions / Owner / Target Date

Intermediate Containment: please list Owner and Target
:Date

Final Permanent Corrective Action:please list Owner and

:Target Date

Intermediate Containment: please list Owner and Target

:Date

Final Permanent Corrective Action:please list Owner and Target

:Date

Picture of corrected state

:Date

Other Plants