System POTENTIAL FMEA Number:

FAILURE MODE AND EFFECTS ANALYSIS

Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Action Results
Item /

Classification
Current Design Current Design

Occurrence

Detection
Severity
Controls Controls

R.P.N.
Function Potential Potential Responsibility & Target

Occurrence
Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure Completion Date

R.P.N.
Actions Taken &
Requirements Effective Date
Prevention Detection
System POTENTIAL FMEA Number:
FAILURE MODE AND EFFECTS ANALYSIS
Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Action Results
Item

Classification
Current Design Current Design

Occurrence

Detection
Severity
Controls Controls

R.P.N.
Potential Potential Responsibility & Target

Occurrence
Requirements Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure Completion Date

R.P.N.
Actions Taken &
Function Effective Date
Prevention Detection
System POTENTIAL FMEA Number:
FAILURE MODE AND EFFECTS ANALYSIS
Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Action Results
Item /

Classification
Current Design Current Design

Occurrence

Detection
Severity
Controls Controls

R.P.N.
Function Potential Potential Responsibility & Target

Occurrence
Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure Completion Date

R.P.N.
Actions Taken &
Requirements Effective Date
Prevention Detection
System POTENTIAL FMEA Number:
FAILURE MODE AND EFFECTS ANALYSIS
Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Action Results
Item

Classification
Current Design Current Design

Occurrence

Detection
Severity
Controls Controls

R.P.N.
Potential Potential Responsibility & Target

Occurrence
Requirements Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure Completion Date

R.P.N.
Actions Taken &
Function Effective Date
Prevention Detection
System POTENTIAL FMEA Number:
FAILURE MODE AND EFFECTS ANALYSIS
Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Action Results
Item

Classification
Current Process

Occurrence
Current Detection Design Controls

Detection
Severity
Controls

R.P.N.
Potential Potential Responsibility & Target

Occurrence
Requirements Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure Completion Date

R.P.N.
Actions Taken &
Function Effective Date
Prevention Cause Failure Mode
System POTENTIAL FMEA Number:
FAILURE MODE AND EFFECTS ANALYSIS
Sub-system (DESIGN FMEA) Page of

Component Design Responsibility: Prepared by:

Model Yr (s) / Program (s): Key Date FMEA Date (orig.) (Rev.)
Core Team:

Target Completion
Action Results
Item

Responsibility
Classification
Current Design Current Design

Occurrence

Detection
Severity
Controls Controls

R.P.N.
Potential Potential

Date

Occurrence
Requirements Potential Failure Mode Recommended Action

Detection
Severity
Effect(s) of Failure Cause(s) of Failure

R.P.N.
Actions Taken &
Function Effective Date
Prevention Detection