Root Cause Analysis Page 1 of 5

Date:

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

I 7. Pilot of implementation

8. Implementation

C 9. Control/Monitoring Plan (including Process Metrics)10. Lessons Learned

Do in Visio, then copy to here. Keep Visio page rectangular no more than 7.5 inches wide.

Sample

This form is a tool for finding causes of process problems and developing actions for eliminating, preventing, and minimizing future problems.

6. Solutions & Prevention steps development (including cost/benefit)

2.Process Map

Page 2 of 5

4. Cause/Effect DiagramRemember Do in Visio, then copy to here. Keep Visio shape rectanular no more than 7.5 inches wide.

Cloud potential

root causes

5. Verifying root cause with data

Page 3 of 5

Process Incident Investigation

Root Cause Investigation

Put Problem Here

SAMPLE

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

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

Cost BenefitAnnualized cost of problem 1 $0.00Percent 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

Root Cause Resolution Page 4 of 5

9. Control Plan (include process metrics)

Root CauseProposedSolutions

Practical Methods Effectiveness Feasibility Cost Benefit Overall Action

Lessons Learned

Root Cause Investigation Team:Role Name Business Phone Cell PhoneProcess 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 DATESAssigned Due Completed Person Task

Root Cause Investigation

Page 1 R 3 10/24/2002 FMEA For

Process Step/Input Potential Failure Mode Potential Failure Effect Potential Causes Current Controls RPN00000000000000000000000000000000

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0Page 2 R 3 10/24/2002 FMEA For

Process Step/Input Potential Failure Mode Potential Failure Effect Potential Causes Current Controls RPN0000000000000000000000000000000

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Page 3 R 3 10/24/2002 FMEA For

Process Step/Input Potential Failure Mode Potential Failure Effect Potential Causes Current Controls RPN00000000000000000000000000000

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Page 4 R 3 10/24/2002 FMEA For

Process Step/Input Potential Failure Mode Potential Failure Effect Potential Causes Current Controls RPN000000000000000000000000000

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Actions Recommended Responsibility Action Taken RPN00000000000000000000000000000000

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Actions Recommended Responsibility Action Taken RPN0000000000000000000000000000000

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Actions Recommended Responsibility Action Taken RPN00000000000000000000000000000

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Actions Recommended Responsibility Action Taken RPN000000000000000000000000000

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SEVERITY EVALUATION CRITERIA

Effect Criteria: Severity of Effect RankingHazardous- 10

Hazardous- 9

With warning

Very High System / item inoperable, with loss of primary function 8

High 7

Moderate 6

Low 5

Very Low 4

Minor 3

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

Very high severity ranking when a potential failure mode effects safe system operation

and/or involves noncompliance with a government regulation with warning

System / item operable, but at a reduced level of performance. Customer dissatisfied.

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

System / item operable, but comfort / convenience item(s) operable at a reduced level of performance. Customer experiences some dissatisfaction.

Fit & Finish / Squeak & Rattle item does not conform. Defect noticed by most customers.

Fit & Finish / Squeak & Rattle item does not conform. Defect noticed by average customers

Very Minor 2

None No effect 1

Fit & Finish / Squeak & Rattle item does not conform. Defect noticed by discriminating customers

OCCURANCE EVALUATION CRITERIA

Likelihood Failure Mode Will Occur

Probability of failure Possible failure Rates Ranking> or = 1 in 2 10

High: Repeated Failures 1 in 8 8

1 in 20 71 in 80 61 in 400 5

1 in 2,000 4Low: Relatively few failures 1 in 15,000 3

1 in 150,000 2

< or = 1 in 1,5000,000 1

Very High: Failure is almost inevitable

Moderate: Occasional 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

10

Very remote 9

Remote 8

Very Low 7

Low 6

Moderate 5

Moderately High 4

High 3

Very High 2

Almost Certain 1

Absolute Uncertainty

Process Control will not and/or cannot detect a potential cause / mechanism and subsequent failure mode; or there is no Process Control

Very remote chance Process Control will detect a potential cause / mechanism and subsequent failure modeRemote chance Process Control will detect a potential cause / mechanism and subsequent failure mode

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

Low chance Process Control will detect a potential cause / mechanism and subsequent failure mode

Moderate chance Process Control will detect a potential cause / mechanism and subsequent failure mode

Moderately high chance Process Control will detect a potential cause / mechanism and subsequent failure mode

High chance Process Control will detect a potential cause / mechanism and subsequent failure mode

Very high chance Process Control will detect a potential cause / mechanism and subsequent failure mode

Process Control will almost certainly detect a potential cause / mechanism and subsequent failure mode