JUDUL PROSES

TANGGAL DIMULAI
TANGGAL SELESAI

KETUA
ANGGOTA

FASILITATOR
NOTULEN

SASARAN

Project Status
Status COMPLETE
TOTAL FAILURE MODE……….
 LANGKAH 2
ALUR PROSES

PROSES
1 2 3 4 5

SUBPROSES SUBPROSES SUBPROSES SUBPROSES SUBPROSES

g
h

i
SUBPROSES

MODUS KEGAGALAN MODUS KEGAGALAN MODUS KEGAGALANMODUS KEGAGALANMODUS KEGAGALAN

 AMKD Langkah 4 - Analisis Hazard AMKD Langkah 5 - Identifikasi Tindakan & Outcome
MODUS POTENSI HAZARD SKORING Analisis Pohon Keputusan Tindakan /
Kegagalan : PENYEBAB Alasan untuk
K N P A A P mengakhiri
e i o d p r
g l i a a o
a a n k k s
w i a a e
a T h h s
t H u
a P a n K m ?
n r z g o u Tipe
o a g n d Tindaka
b r a t a n
Evaluasi awal a d l r h (Kontro
modus b o l,
kegagalan i K l d terima,
sebelum l e / i Elimina
i l P si)
t e e d
a m n e
s a g t
h e e
a n k
n d s
a i
? l
i ?
a
dakan & Outcome
U Y D
k a u
u n k
r g u
a n
n B g
e a
O r n
u t
t a M
c n a
o g n
m g a
e u j
n e
g m
e
J n
a
w
a
b
 Action Plan :………………………
Failure Mode CAUSE Recommendation(s) Action(s) to Implementation
achieve by Whom
recommendations
(How)

ACTION PLAN: ………

Failure Mode CAUSE Recommendation(s) Action(s) to Implementation

achieve by Whom
recommendations
(How)
 Implementation Implementation Resource Resource Evidence of Monitoring &
by when of the place required required completion evaluation
(Where) (Time) (Money) arrangements

ACTION PLAN: …………………………

Implementation Implementation Resource Resource Evidence of Monitoring &

by when of the place required required completion evaluation
(Where) (Time) (Money) arrangements
Sign-off by Sign-off
Date

Sign-off by Sign-off
Date