Root Cause Analysis (RCA)

• Location

  Select

• Conducted on

  Date

• Prepared by

• Reference number (Generated from Issue)

• Incident Summary

Interim Containment

• Describe what has been put in place to stop the issue from escalating?

  Select Human factors Materials Measurement Equipment Process Environment

  • Human factors
  • Materials
  • Measurement
  • Equipment
  • Process
  • Environment

• What corrective actions have been implemented to improve the human factor cause of this accident?

  Select Lessons Learnt communicated Re-trianing Other

  • Lessons Learnt communicated
  • Re-trianing
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• What corrective actions have been implemented to improve the materials used in this accident?

  Select New supplier Improved materials Other

  • New supplier
  • Improved materials
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• What corrective actions have been implemented to improve the measurement aspects of this accident?

  Select Re-calibration Delays managed Other

  • Re-calibration
  • Delays managed
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• What corrective actions have been implemented to improve the equipment used in this accident?

  Select Fixed equipment Quarantined equipment Disposed of equipment Other

  • Fixed equipment
  • Quarantined equipment
  • Disposed of equipment
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• What corrective actions have been implemented to improve the process related to this accident?

  Select Process reviewed Process written Other

  • Process reviewed
  • Process written
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• What corrective actions have been implemented to improve the environment associated with this accident?

  Select Improved waste management Additional spill equipment Controlled work area Other

  • Improved waste management
  • Additional spill equipment
  • Controlled work area
  • Other

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

• Has this action been completed?

  Yes

  No

Verify and Determine the root cause

• You can use the simple Ishikawa (Fishbone) principle to determine a potential root cause as a brain storming tool with the colleagues or the 5 Why process

  

• Which root cause analysis will you use?

  Select 5 Why Ishikawa Other

  • 5 Why
  • Ishikawa
  • Other
5 Why Analysis (click the green + button to complete)

• What is the problem you are going to root cause analyse

• Why?

• Why?

• Why?

• Why?

• Why?

• As determined by the 5Why above, what are the Immediate/Direct Causes (circumstances that immediately precede the accident)

  Select Slip Trip Stab / Puncture Cut / Laceration Lifting / Carrying Pushing / Pulling Fall (same level) Fall from height Unauthorised use of equipment Not wearing required PPE Not following training Struck by moving vehicle Equipment Fault or Failure Personal attack Contact with moving machinery Struck by falling / flying objects Contact with electricty Struck against fixed / stationary object Removal of safety guards Exposure / contact with harmful substance(s) Burns / Scalds from exposure to Fire or Heat Trap or Pinch Horseplay Non- Injury i.e. fainting, nose bleed, black out, rash, bee sting, etc.

  • Slip
  • Trip
  • Stab / Puncture
  • Cut / Laceration
  • Lifting / Carrying
  • Pushing / Pulling
  • Fall (same level)
  • Fall from height
  • Unauthorised use of equipment
  • Not wearing required PPE
  • Not following training
  • Struck by moving vehicle
  • Equipment Fault or Failure
  • Personal attack
  • Contact with moving machinery
  • Struck by falling / flying objects
  • Contact with electricty
  • Struck against fixed / stationary object
  • Removal of safety guards
  • Exposure / contact with harmful substance(s)
  • Burns / Scalds from exposure to Fire or Heat
  • Trap or Pinch
  • Horseplay
  • Non- Injury i.e. fainting, nose bleed, black out, rash, bee sting, etc.

• As determined by the 5 Why above, what is the Basic/Root Cause for the accident?

  Select Personal/ Human Factors Job/ System Factors

  • Personal/ Human Factors
  • Job/ System Factors

• What was the Person/ Human Factor Root cause?

• What is the job/ system factor of the root cause

Prevent Recurrence

• Has the problem has reoccurred since implementation of all actions.

  yes

  no

• The root cause analysis should be reviewed and additional prevenatative actions implemented

• Does a risk assessment exist for this task?

  Yes

  No

• Has the risk assessment been reviewed?

  Yes

  No

• The risk assessment must be reviewed before closing this investigation

• What is the risk assessment reference?

• A risk assessment must be devised and communicated. Please raise an action to complete an assessment as required in QSHE SOP 006

  

• Has the procedure/ process been updated?

  Yes

  No

• Have the results and improvements been communicated to all affected persons?

  Yes

  No

• Has the corrective action been witnessed?

  Yes

  No

• If the answer is yes to all of the above in this section, then the investigation is ready to be closed

End of Investigation - Sign off

• Team Leader sign off:

  Sign

• Completion Date

  Date