5 WHY Incident Investigation - duplicate

• Incident description -

• Job Number -

• Location -

• Conducted on -

  Date

• Prepared by - BRADLEY LEWIS

• Document No. -

1. INVESTIGATIVE TEAM MEMBERS

• Names of investigative team -

2. IMPORTANT

• Has relevant manager been notified about incident?

  yes

  no

• Time and Date

• Person notified

• INFORM BECHTEL

• Has the Quality Department been notified?

  yes

  no

• Time and date

• Person notified

• D&A TEST REQUIRED WITHIN 2Hrs

3. JOB DETAILS

• Date and time of incident

  Date

• Part Affected

• Part Returned?

• Department responsible

  Select Near Miss Personal Injury Environmental Equipment Damage / Process Loss

  • Near Miss
  • Personal Injury
  • Environmental
  • Equipment Damage / Process Loss

• Has a meeting been arranged?

  yes

  no

• inform management

• Other - List

• Person(s) involved

• Plant / Equipment involved

• Injuries / Damage sustained

• Damages cost estimate

• Sequence of events

4. EVIDENCE

• Photographs

  Media

• Enter drawings?

Drawing

• Drawing

  Drawing

• Enter statements?

Statement

• Statement

• Signature

  Sign

5. 5 WHY

• 1. Why did the incident happen?

• undefined

• 2. Why did 1 happen?

• Supporting data

• 3. Why did 2 happen

• Supporting data

• 4. Why did 3 happen?

• Supporting data

• 5. (Optional) Why did 4 happen?

• Supporting data

6. ROOT CAUSE (What was the answer to the last question?)

• Enter root cause?

Root cause

• Root Cause

  Select Risk Assessment Procedure Design Quality Control Maintenance Human Factors Management Training Communication Environmental Other - List Below

  • Risk Assessment
  • Procedure
  • Design
  • Quality Control
  • Maintenance
  • Human Factors
  • Management
  • Training
  • Communication
  • Environmental
  • Other - List Below

7. RECOMMENDATIONS

• Enter recommendation?

Recommendation

• Recommendation