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This form is a tool for gathering data about an opportunity to developing actions for eliminating,
preventing, minimizing and improving our environment.
C.A # Page 1 of 5
Incident Date: Initiated by: Date:
Initial Investigating team:
Step (not all required, depending on problem) Initial and Date completed
D 1 Define the problem
2. Map Process (if required)
M 3. Gather data
4. Choose the Team
A 5. Cause/Effect Analysis (Seeking Root Cause)
6. Verifying root cause with data
I 7. Solutions & Prevention steps development (including cost/benefit)
8. Action Plan for implementation
C 9. Control/Monitoring Plan (including Process Metrics)
10. Lessons Learned
1.Define the opportunity Describe the incident. What was defect, how many, how often, etc.
TRANSIT
3. Gather Data: This is a validation list, survey employees involved, machine capability, etc…
Page 2 of 5
7.Recommended Solutions
Opportunity
Cost Benefit
Annualized cost of problem 1 $0.00
Percent of problem reduction 2 0%
Cost of proposed solution 3 $0.00
Total first year savings (1 x 2 - 3) $0.00
WHO
WHAT
WHERE
WHEN
WHY
HOW
WHO
WHAT
WHERE
WHEN
WHY
HOW
WHO
WHAT
WHERE
WHEN
WHY
HOW