Potential

Failure Mode and Effects Analysis

(Design FMEA)

_______ System FMEA Number:

_______ Subsystem Page:
_______ Component Design Responsibility: Prepared By:

Model Year(s)/Vehicle(s): FMEA Date (Orig.):

Key Date: FMEA Date (Rev.):
Core Team:

Design C Potential O D Action Results

Function Potential Potential S l Cause(s)/ c Current e R Responsibility
Failure Effect(s) of e a Mechanism(s) c Design t P Recommended & Target Actions S O D R
Requirements Mode Failure v s of Failure u Controls e N Actions Completion Date Taken e c e P
s r c v c t N

H02D040A Rev. 1 Print Date: 07/26/2021