Root Cause Template

Root Cause Analysis
Page 1 of 5
This form is a tool for finding causes of process problems and developing actions for eliminating,
preventing, and minimizing future problems.
Incident Date:
Investigator:
RCA Initiated by:
1.Define the problem
Describe the incident. What was defect, how many, how often, etc.
Step (not all required, depending on problem)

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
Date:
Date completed
Process Incident Investigation
Page 2 of 5
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
Root Cause Investigation

6.Recommended Solutions
Root Cause
Page 3 of 5
Double-click on template and enter data with Visio
Proposed
Solutions
Practical Methods
Scale: 1-None 2-Somewhat 3-Moderate 4-Very 5-Extreme

Cost Benefit
Annualized cost of problem
Percent of problem reduction
Cost of proposed solution
1
2
3
Total first year savings (1 x 2 - 3)

7- 8. Action plan for implementation
Who, what , when, where and how
If FMEA needed go to FMEA tab
$0.00
0%
$0.00
$0.00
Effectiveness
Approval needed by:
Feasibility
Cost Benefit
Overall
Action
Root Cause Resolution
Page 4 of 5
9. Control Plan (include process metrics)
Lessons Learned
Root Cause Investigation Team:

Role
Process Owner:
Team Leader:
OE Support:
Team member:
Team member:
Team member:
Team member:
Team member:
Name
Business Phone
Cell Phone
Team member:
Team member:
Root Cause Investigation
Page 5 of 5
Assignments Page
DATES
Assigned
Due
Completed
Person
Task
Page 1
R 3 10/24/2002
FMEA For
Process Step/Input
Potential Failure Mode
Potential Failure Effect
SE
V Potential Causes
OC
C Current Controls
D
ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 2
R 3 10/24/2002
FMEA For
Process Step/Input
SE
V Potential Causes
OC
C Current Controls
D
ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 3
R 3 10/24/2002
FMEA For
Process Step/Input
SE
V Potential Causes
OC
C Current Controls
D
ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 4
R 3 10/24/2002
FMEA For
Process Step/Input
SE
V Potential Causes
OC
C Current Controls
D
ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Actions Recommended
Responsibility
Action Taken
SE OC D
V C ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Actions Recommended
Responsibility
Action Taken
SE OC D
V C ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Actions Recommended
Responsibility
Action Taken
SE OC D
V C ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Actions Recommended
Responsibility
Action Taken
SE OC D
V C ET RPN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SEVERITY EVALUATION CRITERIA

Effect
Criteria: Severity of Effect
Ranking
Very high severity ranking when a potential failure mode effects safe
system operation
Without warning and/or involves noncompliance with a government regulation without
warning
10
Hazardous-
Very high severity ranking when a potential failure mode effects safe
system operation
With warning
and/or involves noncompliance with a government regulation with

warning
Very High
System / item inoperable, with loss of primary function

System / item operable, but at a reduced level of performance.
Customer dissatisfied.
Moderate
System / item operable, but comfort / convenience item(s) inoperable.

Customer experiences discomfort.
Low
System / item operable, but comfort / convenience item(s) operable

at a reduced level of performance. Customer experiences some
dissatisfaction.
Very Low
Fit & Finish / Squeak & Rattle item does not conform. Defect noticed
by most customers.
Minor
by average customers
Hazardous-
High
Very Minor
by discriminating customers
None
No effect
OCCURANCE EVALUATION CRITERIA

Likelihood Failure Mode Will Occur
Probability of failure
Possible failure Rates
Ranking
Very High: Failure is almost

inevitable
> or = 1 in 2
10
1 in 8
1 in 20
1 in 80
1 in 400
1 in 2,000
1 in 15,000
7
6
5
4
3
1 in 150,000
< or = 1 in 1,5000,000
High: Repeated Failures

Moderate: Occasional
Failures
Low: Relatively few failures
Remote: Failure is highly
unlikely
DETECTION EVALUATION CRITERIA

Likelihood the cause will be detected using the process controls
Detection
Criteria: Likelihood of Detection by Process Control
Ranking
Absolute
Uncertainty
Process Control will not and/or cannot detect a potential cause / mechanism
and subsequent failure mode; or there is no Process Control
10
Very remote
Very remote chance Process Control will detect a potential cause /

mechanism and subsequent failure mode
Remote chance Process Control will detect a potential cause / mechanism
and subsequent failure mode
Very Low
Very low chance Process Control will detect a potential cause / mechanism
Low
Low chance Process Control will detect a potential cause / mechanism and
subsequent failure mode
Moderate
Moderate chance Process Control will detect a potential cause / mechanism

Moderately High
Moderately high chance Process Control will detect a potential cause /

mechanism and subsequent failure mode
High
High chance Process Control will detect a potential cause / mechanism and
subsequent failure mode
Very High
Very high chance Process Control will detect a potential cause / mechanism
Almost Certain
Process Control will almost certainly detect a potential cause / mechanism

Remote

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Root Cause Analysis

RCA Initiated by:

1.Define the problem

Step (not all required, depending on problem)

Process Incident Investigation

Put Problem Here

5. Verifying root cause with data

Root Cause Investigation

Double-click on template and enter data with Visio

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

Total first year savings (1 x 2 - 3)

If FMEA needed go to FMEA tab

Approval needed by:

Root Cause Resolution

9. Control Plan (include process metrics)

Root Cause Investigation Team:

Root Cause Investigation

Potential Failure Mode

Potential Failure Effect

Potential Failure Mode

Potential Failure Effect

Potential Failure Mode

Potential Failure Effect

Potential Failure Mode

Potential Failure Effect

SEVERITY EVALUATION CRITERIA

and/or involves noncompliance with a government regulation with

System / item inoperable, with loss of primary function

System / item operable, but comfort / convenience item(s) inoperable.

System / item operable, but comfort / convenience item(s) operable

OCCURANCE EVALUATION CRITERIA

Possible failure Rates

Very High: Failure is almost

High: Repeated Failures

DETECTION EVALUATION CRITERIA

Very remote chance Process Control will detect a potential cause /

Moderate chance Process Control will detect a potential cause / mechanism

Moderately high chance Process Control will detect a potential cause /

Process Control will almost certainly detect a potential cause / mechanism

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