FMEA Form v3.

FMEA Form

Process/Product Name: Prepared By:

Responsible: FMEA Date (Orig.): (Rev.):

Potential Failure Potential Failure

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Process Step/Input Potential Causes Current Controls Action Recommended Resp. Actions Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Mode Effects
SEVERITY (1 - 10)

SEVERITY (1 - 10)
RPN

RPN
What are the
What is the impact on
What is the process In what ways could the What causes the step or What controls exist that recommended actions for Who is responsible for What actions were
the customer if this
step or feature under step or feature go feature to go wrong? (how either prevent or detect reducing the occurrence of making sure the actions completed (and when) with
failure is not prevented
investigation? wrong? could it occur?) the failure? the cause or improving are completed? respect to the RPN?
or corrected?
detection?

0 0

0 0

0 0

0 0

0 0

0 0

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 FMEA Form v3.0

FMEA Form

Process/Product Name: Prepared By:

Responsible: FMEA Date (Orig.): (Rev.):

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the
What causes the What controls recommended Who is What actions
What is the In what ways impact on the
step or feature exist that either actions for reducing responsible for were completed
process step or could the step or customer if this
to go wrong? prevent or the occurrence of making sure (and when) with
feature under feature go failure is not
(how could it detect the the cause or the actions are respect to the
investigation? wrong? prevented or
occur?) failure? improving completed? RPN?
corrected?
detection?

Fill carafe Wrong Coffee to Faded level Visual Replace old Mel Carafe
with water amount of strong or 8 marks on 4 Inspection 4 128 carafes replaced 8 1 3
water weak carafe 9/15
Water spilled None Train Flo Trained on
8 from carafe 5 9 360 employees 9/20 8 2 7

Water too Coffee too Faucet not Finger Train Flo Trained on
warm strong 8
allowed to 8 4 256 employees 9/20 8 2 6
run cool
Employee None Train Flo Trained on
unaware of employees 9/20
8 7 7 392 8 1 8
need for cool
water
Unclean Foreign Carafe not Visual Appoint Alice Vera
carafe objects in 10 washed 4 Inspection 4 160 inspector before appointed 10 1 4
coffee storage 9/21
Bad tasting Carafe Training Create storage Alice Bin & visual
coffee 10 stored 7 5 350 & instructions instructions 10 2 3
improperly done 9/25

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 FMEA Form v3.0

FMEA Form

RPN
24

112

96

64

40

60

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 Severity Scale
Adapt as appropriate

Effect Criteria: Severity of Effect Ranking

Hazardous - May expose client to loss, harm or major disruption -

10
Without Warning failure will occur without warning

Hazardous - May expose client to loss, harm or major disruption -

9
With Warning failure will occur with warning

Major disruption of service involving client interaction, resulting in either associate

Very High 8
re-work or inconvenience to client

Minor disruption of service involving client interaction and resulting in either

High 7
associate re-work or inconvenience to clients

Major disruption of service not involving client interaction and resulting in either
Moderate 6
associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and resulting in either
Low 5
associate re-work or inconvenience to clients

Minor disruption of service involving client interaction that does not result in either
Very Low 4
associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and does not result in
Minor 3
either associate re-work or inconvenience to clients

No disruption of service noticed by the client in any capacity and does not result in
Very Minor 2
either associate re-work or inconvenience to clients

None No Effect 1
 Occurrence Scale

Per Item Failure

Probability of Failure Time Period
Rates

More than once per day >= 1 in 2

Very High: Failure is almost inevitable
Once every 3-4 days 1 in 3

Once every week 1 in 8

High: Generally associated with processes similar to
previous processes that have often failed
Once every month 1in 20

Once every 3 months 1 in 80

Moderate: Generally associated with processes similar

to previous processes which have experienced Once every 6 months 1 in 400
occasional failures, but not in major proportions

Once a year 1 in 800

Low: Isolated failures associated with similar

Once every 1 - 3 years 1 in 1,500
processes

Very Low: Only isolated failures associated with almost

Once every 3 - 6 years 1 in 3,000
identical processes

Remote: Failure is unlikely. No failures associated with

Once Every 7+ Years 1 in 6000
almost identical processes
Ranking

10

1
 Detection Scale

Criteria: Likelihood the existence of a defect will be detected by

Detection process controls before next or subsequent process, -OR- Ranking
before exposure to a client

Almost Impossible No known controls available to detect failure mode 10

Very remote likelihood current controls will

Very Remote 9
detect failure mode

Remote likelihood current controls will

Remote 8
detect failure mode

Very low likelihood current controls will

Very Low 7
detect failure mode

Low Low likelihood current controls will detect failure mode 6

Moderate likelihood current controls will

Moderate 5
detect failure mode

Moderately high likelihood current controls will

Moderately High 4
detect failure mode

High High likelihood current controls will detect failure mode 3

Very high likelihood current controls will

Very High 2
detect failure mode

Current controls almost certain to detect the failure mode. Reliable

Almost Certain detection controls are known 1
with similar processes.
 FMEA Form v3.0

FMEA Form

Process/Product Name: Food Order Delivery Prepared By: Team Lead

Responsible: Manager FMEA Date (Orig.): May 1st (Rev.): May 6th

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the
What causes the What controls recommended Who is What actions
What is the In what ways impact on the
step or feature exist that either actions for reducing responsible for were completed
process step or could the step or customer if this
to go wrong? prevent or the occurrence of making sure (and when) with
feature under feature go failure is not
(how could it detect the the cause or the actions are respect to the
investigation? wrong? prevented or
occur?) failure? improving completed? RPN?
corrected?
detection?

Changing May not Run out of Not carrying Won't know Give vendor a Manager Directions
Vendors deliver on key menu proper until delivery 30-day trial created,
time items quantities copied and
10 8 10 800 distributed 10 6 10
on May 5th

0 Have vendor Manager Instituted on 10 4 1

call to confirm May 5th
quantities
0 Impose Manager Instituted on 10 6 10
penalties for May 6
missed items
0
0
0
0
0
0
0

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 FMEA Form v3.0

FMEA Form

RPN
600

40

600

0
0
0
0
0
0
0

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 FMEA Form v3.0

FMEA Form

Process/Product Name: Packaging Pick-up Orders Prepared By: Team

Responsible: Wesley FMEA Date (Orig.): 25-May (Rev.):

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the
What causes the What controls recommended Who is What are the
What is the In what ways impact on the
step or feature exist that either actions for reducing responsible for completed
process step or could the step or customer if this
to go wrong? prevent or the occurrence of making sure action taken with
feature under feature go failure is not
(how could it detect the the cause or the actions are the recalculated
investigation? wrong? prevented or
occur?) failure? improving completed? RPN?
corrected?
detection?

Chef to put Chef gets Delay of all 10 It takes too 10 White Board 4 400 Cross-Train all Scott 27-May 10 7 1
food into backed up food orders much time to showing food kitchen staff to
containers with orders package order timing handle pick-up
orders packaging
0
0
0
0
0
0
0
0
0
0
0
0
0
0

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 FMEA Form v3.0

0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

RPN
70

0
0
0
0
0
0
0
0
0
0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

0
0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.