Root Cause Analysis Page 1 of 5

This form is a tool for finding causes of process problems and developing actions for eliminating, Date:
preventing, and minimizing future problems.
Incident Date: 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) Date completed

D 1 Define the problem
2. Map Process (if required)
M 3. Gather data
4. Cause/Effect Analysis (Seeking Root Cause)
A 5. Verifying root cause with data
6. Solutions & Prevention steps development (including cost/benefit)
I 7. Pilot of implementation
8. Implementation
C 9. Control/Monitoring Plan (including Process Metrics)
10. Lessons Learned
2.Process Map
Do in Visio, then copy to here. Keep Visio page rectangular no more than 7.5 inches wide.
Sample
 Process Incident Investigation Page 2 of 5
4. Cause/Effect Diagram
Remember Do in Visio, then copy to here. Keep Visio shape rectanular no more than 7.5 inches wide.

SAMPLE

Put Problem Here

Cloud potential
root causes

5. Verifying root cause with data

Root Cause Investigation Page 3 of 5

6.Recommended Solutions Double-click on template and enter data with Visio Approval needed by:

Proposed
Root Cause Solutions
Practical Methods Effectiveness Feasibility Cost Benefit Overall Action

Scale: 1-None 2-Somewhat 3-Moderate 4-Very 5-Extreme

Cost Benefit
Annualized cost of problem 1 $0.00
Percent of problem reduction 2 0%
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)
Lessons Learned

Root Cause Investigation Team:

Role Name Business Phone Cell Phone
Process Owner:
Team Leader:
OE Support:
Team member:
Team member:
Team member:
Team member:
Team member:
Team member:
Team member:
 Root Cause Investigation Page 5 of 5
Assignments Page
DATES
Assigned Due Completed Person Task
Page 1 R 3 10/24/2002 FMEA For

SE OC D
Process Step/Input Potential Failure Mode Potential Failure Effect V Potential Causes C Current Controls ET RPN
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0
0
0
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0
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Page 2 R 3 10/24/2002 FMEA For

SE OC D
Process Step/Input Potential Failure Mode Potential Failure Effect V Potential Causes C Current Controls ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
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0
0
0
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0
0
Page 3 R 3 10/24/2002 FMEA For

SE OC D
Process Step/Input Potential Failure Mode Potential Failure Effect V Potential Causes C Current Controls ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
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Page 4 R 3 10/24/2002 FMEA For

SE OC D
Process Step/Input Potential Failure Mode Potential Failure Effect V Potential Causes C Current Controls ET RPN
0
0
0
0
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0
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 SE OC D
Actions Recommended Responsibility Action Taken V C ET RPN
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SE OC D
Actions Recommended Responsibility Action Taken V C ET RPN
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SE OC D
Actions Recommended Responsibility Action Taken V C ET RPN
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SE OC D
Actions Recommended Responsibility Action Taken V C ET RPN
0
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SEVERITY EVALUATION CRITERIA
Effect Criteria: Severity of Effect Ranking
Hazardous- Very high severity ranking when a potential failure mode effects safe 10
system operation
Without warning and/or involves noncompliance with a government regulation without
warning
Hazardous- Very high severity ranking when a potential failure mode effects safe 9
system operation
With warning and/or involves noncompliance with a government regulation with
warning
Very High System / item inoperable, with loss of primary function 8
High System / item operable, but at a reduced level of performance. 7
Customer dissatisfied.
Moderate System / item operable, but comfort / convenience item(s) inoperable. 6
Customer experiences discomfort.
Low System / item operable, but comfort / convenience item(s) operable 5
at a reduced level of performance. Customer experiences some
dissatisfaction.
Very Low Fit & Finish / Squeak & Rattle item does not conform. Defect noticed 4
by most customers.
Minor Fit & Finish / Squeak & Rattle item does not conform. Defect noticed 3
by average customers
Very Minor Fit & Finish / Squeak & Rattle item does not conform. Defect noticed 2
by discriminating customers
None No effect 1
OCCURANCE EVALUATION CRITERIA

Likelihood Failure Mode Will Occur

Probability of failure Possible failure Rates Ranking

Very High: Failure is almost > or = 1 in 2 10
inevitable

High: Repeated Failures 1 in 8 8

1 in 20 7
Moderate: Occasional 1 in 80 6
Failures 1 in 400 5
1 in 2,000 4
Low: Relatively few failures 1 in 15,000 3
1 in 150,000 2
Remote: Failure is highly < or = 1 in 1,5000,000 1
unlikely
DETECTION EVALUATION CRITERIA
Likelihood the cause will be detected using the process controls
Detection Criteria: Likelihood of Detection by Process Control Ranking
Absolute Process Control will not and/or cannot detect a potential cause / mechanism 10
Uncertainty and subsequent failure mode; or there is no Process Control

Very remote Very remote chance Process Control will detect a potential cause / 9
mechanism and subsequent failure mode
Remote Remote chance Process Control will detect a potential cause / mechanism 8
and subsequent failure mode
Very Low Very low chance Process Control will detect a potential cause / mechanism 7
and subsequent failure mode
Low Low chance Process Control will detect a potential cause / mechanism and 6
subsequent failure mode
Moderate Moderate chance Process Control will detect a potential cause / mechanism 5
and subsequent failure mode
Moderately High Moderately high chance Process Control will detect a potential cause / 4
mechanism and subsequent failure mode
High High chance Process Control will detect a potential cause / mechanism and 3
subsequent failure mode
Very High Very high chance Process Control will detect a potential cause / mechanism 2
and subsequent failure mode
Almost Certain Process Control will almost certainly detect a potential cause / mechanism 1
and subsequent failure mode