Delete this box, and Insert Title of Incident Here

insert your company

logo here. Location of Incident:
Date of Incident:

Version Number:
Investigation File
Version Date:

Area Worksheet Description

Title Page This worksheet
Versions Evolution of this workbook and contributors
Investigation Information
Contacts Names and contact info of those involved with the analysis
CM Steps Cause Mapping method, steps and tools
Need Help? Problem Define the problem with the problem outline
281-412-7766 phone 5-Why 5-Why basic Cause Map™ diagram to get started
Cause Mapping® Steps
281-412-7761 fax Cause Map Analyze details, build the full Cause Map diagram
info@thinkreliability.com Solutions Action Items table listing solutions, owner, due dates
Matrix Evaluate possible solutions for implementation
Timeline Sequence of events with date, time, description
www.thinkreliability.com Diagram Diagrams, drawings and images
Template Version: 2020-v1 Additional Information & Tools Photos Photographs and pictures
Copyright 2020 ThinkReliability, Novem, Inc. Process Map Steps of related work processes written as a flowchart
Notes Notes, emails, documents
Info To Get Information to collect during the investigation
END Extra material past this worksheet
CM A copy of the Cause Map tab for reference
Examples & Resources
Excel Tips Tips for using the template in Microsoft Excel
Examples Example Cause Map diagrams
Versions The versions tab is used to keep a log of the evolution of the investigation. This can be helpful with larger, ongoing investigations that build out in multiple
iterations. The log will help track the different versions along with the type of interaction and involvement. Keeping track of the time and duration is optional.

(clock) (in hours)

Version Date Type Description Time Duration Updated By Contributors
1

Total Investigation Hours 0.00

Contacts

Organization Name Location Role Email Office Mobile Notes

Houston, TX Training & Facilitation Services info@thinkreliability.com 281-412-7766 www.thinkreliability.com

1. Problem Additional Tools Use as needed to capture specific information during the investigation.

Timeline Diagram Photos Notes

Problem Outline The sequence of events. Any drawings or sketches. Any photos or images. Notes related to the investigation.
Capture specifics about the problem as well as the Timeline
Date Time Description Diagram Photos Notes

impact to each of the organization's overall goals.

Us e the drawing tools to add any diagram to this worksheet. Example objects
Delete thes e objects if they are not needed. (indus tr ial) Insert any pictures on this worksheet.
Cylinder Drum

Pump

Valve

Exchanger

Expander,
Compres sor
Turbine
Use this box a picture label

Add Detail to Thoroughly Explain the Issue as Necessary Work Process

Possible Solution:
Step 2. Analysis AND Why? Process Map
The flow of a
Deci sion point
Copy and use as needed
Steps withi n a Tas k

Effect Cause

Analysis
Y ES

Evidence:
OR
Document supporting evidence. work process
2.
Title
Proc es s

NO

Cause Map
Evidence: AND/OR Basic Cause-and-Effect Relationship
that is relevant
to the incident.
Evidence:

Impact to AND
Safety

Start a 5-Why Cause Map™ Diagram

Goal
Evidence:

Write down one of the goals that was impacted. Start a 5- Info Any items (evidence) that need
AND

Why Cause Map diagram and expand as necessary. to be collected during the
Evidence:
to Get investigation.
AND
Evidence:
Im pact to
Production Investigation Action List
Goal
This tab is used to track specific information gathering or support tasks for the investigation.
Evidence: The 'Solutions' tab will capture the action items that are selected by the investigation team.

AND
No. Action Item Owner Date Created Due Date Status Completed
1
2

Basic
3

Detailed
4
5
Evidence: 6

3. Solutions
Evaluate Select Best Specify Each action item is essentially a project.
Follow up should evaluate its effectiveness.
Solution Options Solutions Action Plan Solutions may be a change in work process.
Propose Possible Consider the effort IN to the Impact and risk to each
Solutions solution versus the result OUT. goal should be reduced to
an acceptable level. Ref Possible Solution Cause Controlled Work Process
(process to be improved)
Implement?
(yes or no)
No. Specific Actions
(specific actions to be taken)
Owners
(names)
Due Date
.
Measurable
(how will we verify completion
and effectiveness)

Capture ideas in a solution box and High

attach it to the cause it controls. C

Risk Curve

A
B

F
Payback
Risk

Benefit Medium

G H

Low Medium High

Effort
Cost
Effectiveness of Solution(s)
Problem Outline Use the problem outline to define the problem. The problem outline provides a structured checklist to start an investigation. The outline
format moves the focus from individual perspectives to how the organization sees the problem (goals impacted).

What Problem(s)
When Date
Time
Different, unusual, unique
Where Facility, site
Unit, area, equipment
Task being performed
Impact to Each GOAL
Safety
Environment
Customer
Production, Schedule
Property, Equipment
Labor, Time
This Incident $0
Frequency

Annualized Cost $0
Insert Title of Incident Here
5-Why Cause Map™ Diagram
Possible Solution: OR

AND/OR
Evidence:
AND

Impact to
Goal
Insert Title of Incident Here Possible Solution: OR

Cause Map Diagram

™
AND/OR
Evidence:
AND

Impact to
Safety

Impact to
Environment

Impact to
Customer

Impact to
Production,
Schedule

Impact to
Property,
Equipment

Impact to
Labor, Time
Solutions Possible solutions proposed on the Cause Map diagram control specific causes. For each solution, identifying the cause controlled provides continuity from the
analysis. Preventive solutions must make changes to your work process. Identify the process that will be changed or affected by the proposed solution.

Possible Solutions for Consideration Select Implementation - Action Plan

Work Process Implement? Specific Actions Owners Due Date Measurable

Ref. Possible Solution Cause Controlled No. (how will we verify completion
(process to be improved) (yes or no) (specific actions to be taken) (names) .
and effectiveness)
Solutions Matrix
The solutions matrix is a qualitative cost/benefit analysis tool that A B C D 1 2 3 4
can be used evaluate possible solutions.To use the tool, copy your
possible solutions from the Cause Map diagram and place them on
the matrix relative to each other. If considering a large number of E F G H 5 6 7 8
solutions, letters or numbers can be used to represent your different
options. Use either letters or numbers to rank the solutions.

High

Payback
Benefit Medium

Low Medium High

Effort
Cost
Timeline
Use this tab to capture details of the sequence of events leading up to the problem in chronological order.

Date Time Description Source, Reference

Diagram Label (no border)
Use the drawing tools to add
diagrams to this worksheet. Label (border)
Photos Label (no border)
Insert any supporting pictures on this worksheet.
Copy the symbols to the right, then paste and Label (border)
adjust them to highlight specific areas of the photo
as needed.
Process Map
Capturing the detailed steps of the work process can help reveal where Notes: Label (no border)
YES
the specific breakdowns occurred. Use the shapes to the right to Decision #1
document the process from the people closest to the work. Identify Label (border)
where the breakdowns occurred, then use the Cause Map diagram to
ask, "Why?"
NO

Insert process
name here
Notes
Use this tab to keep track of any supporting notes, emails or documents.
Info to Get
Use this tab to keep track of any information required to complete the investigation.

No. Investigation Action Items: Owner Date Created Due Date Status Completed
1
2
3
4
5
6
Insert Title of Incident Here Possible Solution: OR

Cause Map Diagram

™
AND/OR
Evidence:
AND

Impact to
Safety

Impact to
Environment

Impact to
Customer

Impact to
Production,
Schedule

Impact to
Property,
Equipment

Impact to
Labor, Time
Tips for Using the Cause Mapping® Template

in Microsoft Excel® Cau

(cli

two-
(click

FR
(click
 Attend a
Cause Mapping® Workshop
(click to see upcoming workshops)

Attend a
two-hour online short course
(click to see the list of upcoming topics)

Attend a
FREE, 45-minute webinar
(click to save your seat for an upcoming
webinar)
Cause Map™ Diagram Examples
Optional Objects
Heat
COULD
Cause Map Diagram Paper jam ?
2-Why
AND
Why? Why?

Hazard OR
Impact to Employee contacted Fire Fuel
Safety injured hand unprotected
hand
Out of paper ?
AND

Printer is not Info to Get:

functioning
OR
Oxygen
Notes:
Failure Modes Toner cartridge
4-Why empty ?
Parallel Causes (Split)

This Cause Map diagram shows how one OR

effect can require more than one cause.
Hazard
(injury producer)
No power ?
Stress applied
Hazard
Impact to Employee contacted
AND
Safety injured hand unprotected
hand Stress exceeds
Fracture AND
strength
Unprotected,
exposed hand
Strength