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Cause Mapping Investigation Template - General
Cause Mapping Investigation Template - General
25-Worksheets
Version: 2022
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Index 1 of 25 ThinkReliability
File Record Title
Client ID 0
TR Job ID Total Facilitation Hours 0.00 Total Contribution Hours 0.00
Versions 2 of 25 ThinkReliability
Contacts
Contacts 3 of 25 ThinkReliability
1. Problem Additional Tools - Use as needed to capture specific information during the
investigation.
Problem Outline
Capture specifics about the issue and the Timeline Photos Diagram Work Process
consequences. The sequence of events. Any photos or images. Any drawings or sketches. The work process(es)
relevant to the incident.
What Problem(s)
Timeline
Date Diagram
When Date Time Description
Use the drawing t ools to add any diagram to this worksheet. Example objects
Delete t hese object s if they are not needed. (industrial)
Time Cylinder Drum
Safety
Environmental
Expander,
Customer Turbine
Compressor
Production, Schedule
Equipment, Property
Labor, Time
This incident $0
Frequency
Annualized Cost $0
No. Investigation To Dos Owner Date Created Due Date Status Completed
2. Analysis
1
Text
3. Solutions
Evaluate Select Specific Each action item is essentially a project.
Follow up should evaluate its effectiveness.
Solution Options Best Solutions Action Plan Solutions may be a change in work process.
Propose Consider the effort IN to the Impact and risk to each
Possible Solutions solution versus the result goal should be reduced
OUT. 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 veri fy completion
Risk Curve
C
A
B
F
Payback
Medium
Risk
Benefit
G H
CM-Steps 4 of 25 ThinkReliability
Replace this box with
your company logo. Title
Location of Incident 0
Date of Incident
Date of Final Report
Problem Definition 3
Photos 5
Diagram 6
Solutions 10
Resources
Contacts
Versions
Cover 5 of 25 ThinkReliability
Summary of Incident
1-2 sentences.
Incident Description
For a more detailed sequence of events, see Timeline.
Description 6 of 25 ThinkReliability
1. Problem Outline
Title
Summary Description
(Optional)
What Problem(s)
When Date
Time
Different, unique, changed
Where Facility, site
Unit, area
Equipment
Task(s) being performed
GOALS Negative effect to each item below:
Safety
Environmental
Customer
Production, Schedule
Equipment, Property
Labor, Time
This incident $0
Frequency
Annualized cost $0
Problem 7 of 25 ThinkReliability
Title
Area Label
Impact to
GOAL
Recommendation, action, control, idea Cause to be controlled Task to be improved Why or why not it was selected Solution details if needed Evidence it was effective
Ref. Possible Solution Cause Work Process Rationale Specific Action Owner(s) Due Date Status Measurement
Solutions 9 of 25 ThinkReliability
Solutions Matrix
A B C D
Estimated
E F G H BENEFIT of Solution
Expected Result Out
Low High
Matrix 10 of 25 ThinkReliability
Timeline
Timeline 11 of 25 ThinkReliability
Photos
Black text, white glow
Description
Description
Photos 12 of 25 ThinkReliability
. Diagrams
Diagrams 13 of 25 ThinkReliability
Process Map
Steps of a Task, Job A
Steps of an Operation YES Top left
Decision
Top centered
Process Map
No. Information and Evidence to Collect Owner Date Created Due Date Status Completed
1
Text
Notes 16 of 25 ThinkReliability
Resources
Resources 17 of 25 ThinkReliability
END
END 18 of 25 ThinkReliability
Spare Parts Text 12 Text 10
(use as needed)
Text 14 Black text, white glow
Why ? Because...
After Before 1 2 3
Negative Impact to
Near-Miss, Customer
Potential Impact to Potential for
cause Area Label
Safety
Possible Solution: AND/OR
Negative Impact to Idea, suggestion.
Production, OR
Schedule
Evidence: AND
Positive Impact to Info, Facts
Safety
Negative Impact to
Property Info to Get:
Negative Impact to
Labor, Time ? ?
File Name
File Name Convention:
CM - Client - Description - MMDDYY ID - v1JH
Cause Map - Client - Incident Name - MMDDYY - v1JH
Area Label
Impact to
GOAL
Extra CM 20 of 25 ThinkReliability
Solutions - Action Items, Recommendations
Recommendation, action, control, idea Cause to be controlled Task to be improved Why or why not it was selected Solution details if needed Evidence it was effective
Ref. Possible Solution Cause Work Process Rationale Specific Action Owner(s) Due Date Status Measurement
Sols 21 of 25 ThinkReliability
Extra Worksheet
Blank 22 of 25 ThinkReliability
Examples
5-Why Cause Map™ Diagram 6-Why Cause Map™ Diagram 10-Why Cause Map™ Diagram
Contact
Normal valve
operation
Valve
Contact rotated, AND
Driver actuated
Contact looked away Energy
Valve
from route isolation not
energized,
Dust part of job
not isolated
Dust particles collection not plan
location, area working Forklift at Valve
AND Serious hand
optimally location, pinched, cut AND
injury
off route fingers
Person Transporting
inhaled dust AND product
Damage to Forklift hit Technician
particles AND was checking
Work in area pickup pickup
for debris
?
Fingers
Unprotected on edge of
person in Pickup valve
AND AND
area parked on housing Valve was
pad silent, no
noise
No
confirmation,
check if valve
in service
Examples 23 of 25 ThinkReliability
Training Videos
Training 24 of 25 ThinkReliability
Tips for Using the Cause Mapping®
Template
in Microsoft Excel®