Inspection

Failure Modes and Effects Analysis

Specify the function (process step or input)

FUNCTION

Function

Potential Failure Mode

Specify the potential failure mode

Potential Effect

Specify the potential effect

Severity Rating

Potential Cause

Specify the potential effect

Severity Rating

Current Controls

Specify the current control

Detection Rating

RPN

Corrective action

Specify the potential effect

Completion
Full Name and Signature of Facilitator

FMEA Team

MEMBER
Full Name and Signature of Team Member
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.