Title Page

  • Site conducted

  • Date

  • Corrective Action Number?

  • Prepared by?

Containment Activities

  • Expectation:<br>- Was containment performed and corrections found acceptable?

  • Retain evidence of implementation (Include documents or pictures showing Containment/Corrections)

Root Cause Analysis & Corrective Action Implementation

  • Was the Root cause identified? (1 x 1 Worksheet, 5 Whys or other customer required root cause analysis methodology must be used)

  • Does the Root Cause follow correct logic resulting in the true Root Cause being identified?

  • Retain evidence of implementation (Include documents or pictures showing Root Cause Analysis)

  • Have the Corrective Action(s) been completed?

  • Is the Corrective Action(s) effectively implemented?

  • Retain Evidence of Implementation (include any document or pictures)

Systemic / Preventive Actions

  • Is the Systemic / Preventive actions in place?

  • Retain evidence of implementation (Include documents or pictures showing Systemic / Preventive Actions)

  • Was training required for any of the Systemic/Preventive actions performed?

  • Do the Systemic/Preventive actions properly read across to other areas?

  • Are there any other risks that have not been identified within the actions?

  • Has the Systemic/Preventive Actions been effectively implemented?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.