Breakdown RCA sheet

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Has the breakdown affected production

Description of Breakdown

Fitter Attending

• Yes

  No

  N/A

Electrician Attending

• Yes

  No

  N/A

Plant operator

• Yes

  No

  N/A

Plant operator comments

• Yes

  No

  N/A

Fitters / Electrician Comments

• Yes

  No

  N/A

Parts Removed/ Fitted

• Yes

  No

  N/A

Have T Cards been raised

• Yes

  No

  N/A