Information

  • Plant

  • Department

  • Conducted on

  • Prepared by

  • Personnel

Root Cause Analysis

  • Description of the incident ( one phrase )

  • Date and time

  • Shift

Manpower

  • MOST PROBABLE ROOT CAUSE ( to be defined after completing the 5 why's below )

  • Add media

  • Add drawing

  • CONTRIBUTIVE FACTORS

  • BBS factors : * eyes not on task * mind not on task * fatigue * Overconfidence * line of fire * lack of balance

  • PPE : training provided efficient training verified

  • Communication : - supervisor to employee - employee to supervisor - employee to employee

MATERIAL

  • MOST PROBABLE ROOT CAUSE ( to be defined after completing the 5 why's below )

  • Add media

  • Add drawing

  • CONTRIBUTIVE FACTORS

  • recent process change

  • if chemical : SDS available

MACHINE

  • MOST PROBABLE ROOT CAUSE ( to be defined after completing the 5 why's below )

  • Add media

  • Add drawing

  • CONTRIBUTIVE FACTORS

  • guarding inadequate machine guarding no guarding

  • Tools proper tool was not identified proper tool was not available

METHODOLOGIE

  • MOST PROBABLE ROOT CAUSE ( to be defined after completing the 5 why's below )

  • Add media

  • Add drawing

  • CONTRIBUTIVE FACTORS

  • work permit

  • pre-op inspection

  • SOP

WORKPLACE

  • MOST PROBABLE ROOT CAUSE ( to be defined after completing the 5 why's below )

  • Add drawing

  • Add media

  • CONTRIBUTIVE FACTORS

  • noise illumination floor walls

Corrective action Plan

  • Action:

  • Responsible

  • Due Date

  • Follow up: completed ?

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