Puskesmas Dungaliyo

ROOT CAUSE ANALYSIS

(RC A)

Analisis terhadap ..........: ......................................................................................................................

Tim RCA:
Ketua : .........................................................................

Anggota : 1. ...................................................................

2. ...................................................................

3. ...................................................................
4. ...................................................................
5. ...................................................................

Diskripsi singkat kejadian:

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Faktor yang menjadi pencetus (trigger):

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Kronologi kejadian:

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Faktor-faktor yang terkait dengan kejadian:

a. Faktor-faktor yang terkait langsung:

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b. Faktor-faktor yang menunjang terjadinya kejadian:

c. ---------------------------------------------------------------------------------------------------------------------------------------------
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Petugas Tidak mengecek alat timbang yang digunakan

 Puskesmas Dungaliyo
- Petugas tidak teliti menimbang berat bad
Analisis akar masalah (gambarkan diagram tulang ikan/pohon masalah)

Rencana solusi:

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Implementasi danTindak lanjut:

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Pelaporan:
Dilakukan pelaporan kepada ketua manajemen mutu

Ketua : .........................................................................

Anggota : 1. ...................................................................

2. ...................................................................

3. ...................................................................
4. ...................................................................
5. ...................................................................