Root Cause Analysis Page 1 of 5

This form is a tool for finding causes of process problems and developing actions for eliminating, Date:
preventing, and minimizing future problems.
Incident Date: RCA Initiated by:
Investigator:
1.Define the problem Describe the incident. What was defect, how many, how often, etc.

Step (not all required, depending on problem) Date completed

D 1 Define the problem
2. Map Process (if required)
M 3. Gather data
4. Cause/Effect Analysis (Seeking Root Cause)
A 5. Verifying root cause with data
6. Solutions & Prevention steps development (including cost/benefit)
I 7. Pilot of implementation
8. Implementation
C 9. Control/Monitoring Plan (including Process Metrics)
10. Lessons Learned
2.Process Map
Do in Visio, then copy to here. Keep Visio page rectangular no more than 7.5 inches wide.
Sample
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4. Cause/Effect Diagram
Remember Do in Visio, then copy to here. Keep Visio shape rectanular no more than 7.5 inches wide.

SAMPLE

Put Problem Here

Cloud potential
root causes

5. Verifying root cause with data

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6.Recommended Solutions Double-click on template and enter data with Visio Approval needed by:

Proposed
Root Cause Solutions
Practical Methods Effectiveness Feasibility Cost Benefit Overall Action

Scale: 1-None 2-Somewhat 3-Moderate 4-Very 5-Extreme

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

7- 8. Action plan for implementation

Who, what , when, where and how

If FMEA needed go to FMEA tab

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9. Control Plan (include process metrics)
Lessons Learned

Root Cause Investigation Team:

Role Name Business Phone Cell Phone
Process Owner:
Team Leader:
OE Support:
Team member:
Team member:
Team member:
Team member:
Team member:
Team member:
Team member:
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Assignments Page
DATES
Assigned Due Completed Person Task